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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2014

01-08-2014 | Endocrine Tumors

The Impact of Surgical Volume on Racial Disparity in Thyroid and Parathyroid Surgery

Authors: Salem I. Noureldine, MD, Ali Abbas, MD, MPH, Ralph P. Tufano, MD, FACS, Sudesh Srivastav, PhD, Douglas P. Slakey, MD, MPH, FACS, Paul Friedlander, MD, FACS, Emad Kandil, MD, FACS

Published in: Annals of Surgical Oncology | Issue 8/2014

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Abstract

Purpose

The aim of this study was to evaluate the association between surgeon volume and patient outcomes among different race ethnicities undergoing thyroid or parathyroid surgery.

Methods

The nationwide inpatient sample was used to identify all thyroidectomy and parathyroidectomy admissions from 2003 to 2009, using International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) procedure codes. Race, demographic, and clinical characteristics of patients were collected, along with surgeon volume, to predict the length of stay (LOS), complication rates, mortality, and total charges by racial group, using univariate and multivariate analyses.

Results

A total of 106,314 thyroid and parathyroid surgeries were included in the current analysis. Of these patients, 54 % were Caucasian, 11 % African American, 7 % Hispanic, and 3 % Asian. Mean LOS was longer for African American patients (4 ± 8.7 days) than for Caucasians (2.3 ± 5.5 days) [p < 0.001]. African Americans had higher overall complications (16.8 %) compared with Caucasians (11 %), Hispanics (13.5 %), and Asians (12 %) [p < 0.001]. In-hospital mortality was higher for African Americans (0.8 %) compared with that from other race groups (0.3 %) [p < 0.001]. Mean total charges were significantly higher for African Americans ($33,292 ± $67,387) compared with those for Caucasians ($22,855 ± $40,167) (p < 0.001). African Americans had less access to intermediate- (10–99 cases) and high- (>100 cases) volume surgeons compared with Caucasians—45 versus 49 %, and 16 versus 19 %, respectively (p < 0.001). Higher surgeon volume was associated with improved outcomes (p < 0.001). Racial disparity in all investigated outcomes was still significantly evident even after stratification by surgeon volume.

Conclusion

Higher surgeon volume is associated with improved patient outcomes. However, our data suggests that the observed racial disparities in thyroid and parathyroid surgery go beyond access to quality healthcare providers.
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Metadata
Title
The Impact of Surgical Volume on Racial Disparity in Thyroid and Parathyroid Surgery
Authors
Salem I. Noureldine, MD
Ali Abbas, MD, MPH
Ralph P. Tufano, MD, FACS
Sudesh Srivastav, PhD
Douglas P. Slakey, MD, MPH, FACS
Paul Friedlander, MD, FACS
Emad Kandil, MD, FACS
Publication date
01-08-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3610-0

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