Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics.

OBJECTIVES/HYPOTHESIS: Disparities in economic and social parameters have been identified as underlying factors that influence diseases outcomes. We aim to examine the influence of community-specific measures on outcomes related to thyroid surgery.

STUDY DESIGN: A cross-sectional study utilizing the State Inpatient databases and State Ambulatory Surgery and Services databases, 2010 to 2011. Those databases were merged with the County Health Ranking database.

METHODS: The study population included adult (≥18 years) inpatients and outpatients who underwent thyroidectomy. Access and outcomes of thyroidectomy was assessed in relation to demographics and health-risk status of the patient's community.

RESULTS: A total of 14,220 inpatient and 7,215 outpatient thyroidectomies were included. Low-volume surgeons were more likely to operate on patients living in high-risk communities (P < .05). Patients from these communities of high health risk were more likely to be women, and African Americans (P < .05 each). Compared to low-risk communities, patients from high-risk settings had a higher risk of postoperative complications (odds ratio: 1.58, 95% confidence interval: 1.23, 2.04, P < .001). They also experienced longer hospitalization (P = .003) and higher readmission risk (3.0% vs. 1.5%, P = .03). Interestingly, despite divergent and lower outcome parameters, hospital charges for patients of high-risk communities were in the highest quartile (>$34,535.55) compared to low-health-risk communities (P < .001).

CONCLUSIONS: Patients from high-health-risk communities and who are undergoing thyroidectomies are more likely to be women and African Americans. Management of those patients is more likely to be performed by low-volume surgeons and more likely to be associated with unfavorable outcomes.

LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2194-2199, 2016.