S. Jang1, C. J. Balentine1, H. Chen1 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, Alabama, USA
Introduction: Racial disparities in health care and health outcomes have been well documented in most diseases, but there is limited data for hyperparathyroidism. Parathyroidectomy is the only curative therapy for hyperparathyroidism, but its cost and variation in use among different racial and ethnic groups are largely unexamined. The purpose of this study was to examine the association between race and ethnicity and the total hospital cost of parathyroidectomy.
Methods: This retrospective study included 899 consecutive cases in our institution between September 2011 and July 2016 coded as complete parathyroidectomy, parathyroidectomy or exploration of parathyroid, or other parathyroidectomy using ICD-9 and 10 procedure codes. We evaluated demographics, insurance type, and readmission rates. Total length of stay and cost were evaluated using the Mann-Whitney U and the Kruskal-Wallis non-parametric tests. Categorical variables were evaluated with chi-square.
Results: The study population was 66.4% Caucasian, 31.4% African American, 0.7% Hispanic, and 0.3% Asian. Median age was 60 years (range 13-93), 76% were female, and 83% were outpatients. Total hospital costs were greater for African American patients ($5,025.22 ± 6,535.38, P = 0.013) compared to Caucasian patients ($4,787.49 ± $2,241.50) but costs were similar to Hispanic and Asian patients. Compared to Caucasian patients, African American patients were more likely to experience hospital costs greater than $10,000 (6.7% vs 2.1%, P = 0.001). Mean length of stay was 0.99 ± 3.14 for African American patients and 1.33 ± 1.21 for Hispanic patients while it was 0.44 ± 1.28 for Caucasian patients (P <0.001). African American patients were also more likely than Caucasians to be admitted to the ICU (22.7% vs. 13.2%, P < 0.001) and more likely to be readmitted after discharge (4.6% vs. 1.2%, P = 0.001). Among African American patients, male Black patients had a more expensive total hospital cost (trending P = 0.072), higher incidence of cases that cost greater than $10,000 (P = 0.005), longer length of stay (P < 0.001), and higher incidence of ICU admission (P < 0.001) compared to female Black patients.
Conclusion: African American race was associated with higher hospital costs for parathyroidectomy compared to Caucasian patients. The increased cost could be explained in part by longer length of stays after the operation and higher incidence of admission to the ICU. More detailed research and efforts are needed to reduce racial disparity in the management of parathyroidectomy patients.