September 10, 2014 / 8:45 PM / 5 years ago

Race and poverty tied to thyroid surgery outcomes

NEW YORK (Reuters Health) - Minorities and the poor tend to have worse access to the most experienced thyroid surgeons and hospitals than white or more affluent patients, according to a new study.

The research doesn’t delve into why the differences in access exist, but the results suggest the disparity may lead to poorer outcomes for some groups.

“Surgeons who are doing more of these operations are going to have better outcomes and hospitals that are used to handling these cases are going to have better results,” Dr. Adam Hauch said.

“There is a lot of published information out there looking at disparities as far as racial and ethnic disparities as well as socioeconomic disparities in healthcare,” said Hauch, the study’s lead author, from the Tulane University School of Medicine in New Orleans. “They’ve looked at them for a number of healthcare procedures.”

“We thought of pursuing that topic in the area of thyroid surgery, because not much has been looked at with that specific type of surgery,” he added.

The thyroid is a gland that sits toward the front of the neck. It produces several hormones that are important to bodily functions - especially metabolism and growth.

Thyroid surgery is required if the gland develops abnormal growths, becomes cancerous or is not functioning correctly. The thyroid or just part of it may be removed during surgery.

Somewhere between 120,000 and 166,000 thyroid surgeries are performed in the U.S. each year, the authors note in the journal JAMA Otolaryngology - Head and Neck Surgery.

For the new study, they used data collected from 62,722 people who were having thyroid surgery between 2003 and 2009.

Most of the surgeries involved complete removal of the gland for non-cancerous conditions. About 91 percent of the surgeries were done by surgeons who performed fewer than 100 thyroid surgeries per year, which the authors considered a “low volume.”

The researchers found that about 17 percent of patients whose procedures were done by a low-volume surgeon had complications, compared to about 12 percent of patients with high-volume surgeons.

Complications were also more common among patients who had their surgeries at hospitals that didn’t handle many thyroid surgeries. About 18 percent of patients at hospitals with fewer than 48 thyroid surgeries per year had complications, compared to about 15 percent among patients at higher-volume hospitals.

Patients of low-volume surgeons or low-volume hospitals were also more likely to stay in the hospital longer than the patients of high-volume doctors or hospitals.

The researchers found that compared with white patients, Hispanics were about twice as likely to be operated on by low-volume surgeons, as were black patients living in the Northeast. Black patients were also more likely to go to a low-volume hospital in the Midwest and West.

In addition, low-income patients or those on Medicare, the federal insurance for the elderly and disabled, were more likely to have their operation at a low-volume hospital.

Hauch said one reason minorities and people with low incomes may be more likely to see low-volume surgeons or go to low-volume hospitals is access to insurance.

“If you don’t have insurance there are certain hospitals that won’t see the patients,” he said. “That’s the driving force behind Obamacare (the 2010 Affordable Care Act). It’s to try to deliver care to everyone.”

The researchers can’t be sure that lack of insurance is the reason for the differences in access to high-volume surgeons, Hauch cautioned. “What we found was just the association between certain minorities and their access to those higher volume institutions,” he said.

He added that one approach to addressing the differences in outcomes could be to go into the community and have interest groups establish more clinics to reach people who have limited access to healthcare.

As an example, he noted that transplant surgeons in New Orleans have reached out to communities to help educate people about conditions related to transplants and encouraged them to get checked out in clinics.

“Getting higher volume surgeons and hospitals to those patients is the best thing you can garner from all this,” he said.

SOURCE: JAMA Otolaryngology - Head and Neck Surgery, online September 4, 2014.

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