E. A. Alore1, S. Molavi1, C. J. Balentine2,3, J. W. Suliburk1 1Baylor College Of Medicine,Department Of Surgery,Houston, TX, USA 2University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA 3University Of Alabama at Birmingham,Institute For Cancer Outcomes And Survivorship,Birmingham, Alabama, USA
Introduction:
Surgical outcomes for underserved patients facing social and economic disparities are frequently suboptimal. Our institution developed a multidisciplinary endocrine surgical team with carefully implemented postoperative care pathways to aid in the care of disadvantaged patients at our county safety net hospital. The purpose of this study is to compare surgical outcomes after thyroidectomy at our public hospital to outcomes at the private hospital in our institution. We hypothesized that our multidisciplinary patient-centered approach would largely eliminate disparities in postoperative outcomes.
Methods:
We performed a retrospective cohort study of 512 patients undergoing partial or total thyroidectomy at a private teaching hospital and a public safety net hospital within the same academic institution over 77 months from 1/2010 to 5/2016. The cases were performed by the same clinical team including surgery, endocrinology, anesthesiology and pathology. Temporary nerve injury was defined as injury that resolved within 6 months, temporary hypocalcemia was defined as immediate postoperative PTH <10, permanent nerve injury and hypocalcemia were defined as those which persisted >6 months post operatively.
Results:
A total of 358 patients from the public hospital and 154 patients from the private hospital were studied. 91% of patients at the public hospital were from racial/ethnic minorities compared with 42% of private hospital patients (p<0.001). 26% of patients at the public hospital were insured versus 100% at the private hospital (p<0.001). There were no significant differences in age, gender, cancer stage, or size of the thyroid gland. Rates of temporary nerve injury, permanent nerve injury, permanent hypoparathyroidism, postoperative hematoma or ER visits did not differ between groups (Table 1). Rates of temporary hypocalcemia at the public hospital (34.4%) were higher than at the private hospital (17.5%, p=0.001). We performed additional analyses stratified by type of insurance again finding rates of nerve injury, permanent hypoparathyroidism, postoperative hematoma or ER visits did not differ by type of insurance, but temporary hypocalcemia was more common in patients without insurance (38.5% vs 19.8%, p<0.001, Table 1).
Conclusion:
A dedicated endocrine surgery team was able to deliver excellent outcomes for patients lacking insurance and being treated at a public safety net hospital. Our findings suggest that social and economic disadvantages can be largely overcome for endocrine surgery patients with a combination of dedicated surgical care, multidisciplinary team coordination and patient-centered care pathways.
