The Relationship Between Hospital Safety-Net Burden on Outcomes for High-Volume Thyroid Cancer Surgeons
Authors' conclusion
The performance of HV thyroid cancer surgeons differs by a hospital's safety-net burden, with patients treated at high safety-net burden hospitals experiencing higher rates of operative complications, disease-specific mortality, and all-cause mortality.
Study context
- Population
- Patients who underwent surgery for thyroid cancer in California, 1999–2017; High-volume (HV) surgeons (annual case volume ≥10) performing total thyroidectomy; 78% female, median age 5013,848 treated by HV surgeons
- Participants
- 42,347 patients
- Exposure
- HV surgeons at Q4 vs Q1 hospitals
- Outcome
- Perioperative and oncologic outcomes of HV surgeons across safety-net burden quartiles
Methodological detailspopulation-based (California), mixed-effects regression model
- Population-based (California)
- Mixed-effects regression model
Main finding
As reported in the abstract
Absolute risk, Q4 vs Q1 (multivariable analysis)
- Q4
- absolute risk difference, endocrine complications +7%; P = 0.007
- Q4
- absolute risk difference, airway complications +6%; P = 0.004
- Q4
- absolute risk difference, disease-specific mortality +1.3%; P = 0.046
- Q4
- absolute risk difference, all-cause mortality during study period +3%; P = 0.046
Observational data: associations, not effects.
Further findings
Characteristics of patients of HV vs lower-volume surgeons
- Patients of HV surgeons more likely White, upper socioeconomic quartiles and well insured
- all p < 0.001
- HV surgeons in each safety-net burden quartile displayed similar case number distributions
Original publication
The Relationship Between Hospital Safety-Net Burden on Outcomes for High-Volume Thyroid Cancer Surgeons. Thyroid. Published 11 November 2024. doi:10.
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