Explaining the Variation in Surgical Practice for Differentiated Thyroid Cancer in Ontario, Canada

Area of Science:

• Oncology
• Surgical Management
• Health Services Research

Background:

• Surgical treatment extent for differentiated thyroid cancer (DTC) lacks standardization, leading to wide practice variations.
• Geographic disparities in healthcare utilization may stem from physician preferences, as suggested by the Enthusiasm Hypothesis.

Purpose of the Study:

• To investigate the applicability of the Enthusiasm Hypothesis to variations in DTC surgical treatment within Ontario, Canada.
• To analyze the relationship between surgeon practices and geographic differences in thyroid cancer surgery.

Main Methods:

• Population-based study utilizing electronic health records for 28,754 adult patients diagnosed with DTC between 2000 and 2015 in Ontario.
• Analysis of surgical treatment extent (total vs. less-than-total thyroidectomy), surgeon case volumes, and geographic distribution across 14 regions.

Main Results:

• Significant variation in total thyroidectomy rates (45.8% to 77.1%) was observed across Ontario's geographic regions.
• Over 90% of practice variation in thyroidectomy extent was attributable to high-volume surgeons' preferences in high-incidence areas.

Conclusions:

• The Enthusiasm Hypothesis provides a plausible explanation for observed variations in DTC surgical management.
• The practices of high-volume surgeons with a preference for total thyroidectomy in high-diagnosis-rate regions appear to drive practice variations in Ontario.