Disparities in utilization of high-volume thyroid surgeons for Graves disease: a statewide analysis

For patients with Graves disease undergoing surgery, the American Thyroid Association guidelines recommend referral to a high-volume thyroid surgeon (HVTS). However, factors limiting patient utilization of an HVTS are poorly understood.

This study aimed to identify factors associated with utilization of an HVTS for patients with Graves.

This retrospective cohort study analyzed adults with Graves who underwent thyroidectomy from January 2015 to December 2022 in a statewide claims registry. Surgeons were categorized as HV (>25 thyroidectomies/year) or low-volume (LVTS; ≤25 thyroidectomies/year). Logistic regression evaluated patient demographics, travel distance to treating HVTS hospital and closest endocrinologist, household income, area deprivation index, and education.

Among 764 patients treated by 130 surgeons, 17 HVTSs performed the majority (60.4%) of thyroidectomies. Most patients were female (84.3%) and White (51.0%). Patients treated by an HVTS traveled 16.8 miles farther (P < .001). On multivariable analysis, distance traveled to the treating hospital (odds ratio [OR] 1.01; 95% CI, 1.003-1.014) and education of a patient's home zip code (OR 0.87; 95% CI, 0.83-0.91) were significant predicators of using an HVTS. Proximity to an endocrinologist was not associated with utilization (P = .45). Surgery by an HVTS was associated with lower rates of hypocalcemia (18.2% vs 24.8%; P = .03) and cardiac events (10.4% vs 17.2%; P = .008).

Just more than half of patients with Graves disease received guideline-concordant surgical care by an HVTS. Enhancing patient knowledge and awareness of the benefits of HVTS care and solving transportation barriers may improve Graves patients' use of HVTS and outcomes.