J. B. Hamner1, P. Ituarte1, L. Goldstein1, L. Kruper1, S. Chen1, J. Yim1 1City Of Hope National Medical Center,Division Of Surgical Oncology,Duarte, CA, USA
Introduction: Multiple factors including cost and patient motivation have resulted in an increase in the number of thyroidectomies performed in ambulatory settings. Information on practice patterns and rates of outpatient thyroidectomy are limited, however.
Methods: The Healthcare Cost and Utilization Project (HCUP) captures inpatient hospital and ambulatory surgery center data. We evaluated HCUP data for 5 years in California to identify all patients undergoing thyroidectomy. Influence of patient type, hospital, disease and surgery (total vs. partial thyroidectomy) characteristics by year and visit type (inpatient vs. outpatient) were determined by bivariate analysis using Chi-Square test and non-parametric test for trend. A multivariate logistic regression model was used to examine predictors of outpatient thyroidectomy.
Results: 37,188 thyroidectomies were identified with 9,319 (25%) conducted in outpatient settings. Outpatient thyroidectomy accounted for 19.3% of thyroidectomies in 2005, increasing to 30.6% by 2009. Outpatient thyroidectomy was associated with a lower rate of post-operative complications vs. inpatient (1.17% vs. 4.22%, p<0.01). Predictors of outpatient thyroidectomy included younger age and fewer comorbidities. Racial minorities [p-value<0.01] and Medicaid recipients [OR=0.55, p<0.01] had lower odds of outpatient thyroidectomy. Hospital volume influenced outpatient thyroidectomy with intermediate volume centers having higher odds of outpatient thyroidectomy than low or high volume centers (OR=1.18 vs. 0.69 and 0.72).
Conclusion: Outpatient thyroidectomy rates have increased in California, and have fewer recorded complications than inpatient thyroidectomies. This supports the practice of outpatient thyroidectomy in appropriately selected patients. Interestingly, racial minorities and Medicaid recipients had lower odds of outpatient care. These findings suggest that there are multiple systemic factors beyond socioeconomic factors in the selection of patients for outpatient thyroidectomy.