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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Clinical and economic outcomes of thyroid and parathyroid surgery in children
Julie Ann Sosa1, Charles T Tuggle, Tracy S Wang
1Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, USA.
Insights
Pediatric thyroidectomy and parathyroidectomy patients face higher complication rates and costs than adults. Socioeconomic and racial disparities impact access to high-volume surgeons, affecting outcomes.
Area of Science:
- Pediatric Surgery
- Endocrine Surgery
- Health Services Research
Background:
- Adult thyroidectomy/parathyroidectomy outcomes show age and race disparities.
- Limited data exists on pediatric endocrine surgery outcomes.
- Understanding pediatric outcomes is crucial for equitable care.
Purpose of the Study:
- To identify clinical and demographic factors predicting outcomes in pediatric thyroidectomy/parathyroidectomy.
- To analyze complications, length of stay, and costs in pediatric patients.
- To investigate disparities in surgical outcomes based on patient characteristics.
Main Methods:
- Cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample data (1999-2005).
- Included 1199 pediatric patients (≤17 years) undergoing thyroidectomy/parathyroidectomy.
- Used bivariate and multivariate analyses to determine outcome predictors.
Main Results:
- Younger children (0-6 years) experienced higher complication rates, longer hospital stays, and increased costs.
- Lower-income children had worse outcomes (complications, LOS, costs) compared to higher-income peers.
- Pediatric patients had higher endocrine-specific complication rates than adults for both procedures.
Conclusions:
- Pediatric thyroidectomy/parathyroidectomy is associated with higher complication rates than in adults.
- High-volume surgeons correlate with optimized outcomes.
- Disparities in access to high-volume surgeons exist for low-income, Black, and Hispanic children.
Context:
Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes.
Objective:
The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy.
Design:
This study is a cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample hospital discharge information from 1999-2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes.
Subjects:
Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy.
Main Outcome Measures:
Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs.
Results:
The majority of patients were female (76%), aged 13-17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0-6 yr had higher complication rates (22% vs. 15% for 7-12 yr and 11% for 13-17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7-12 yr and 1.8 for 13-17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01).
Conclusions:
Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.
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