G. A. Rubio1, T. M. Vaghaiwalla1, P. P. Parikh1, J. C. Farra1, A. R. Marcadis1, Z. F. Khan1, J. I. Lew1 1University Of Miami Leonard M. Miller School Of Medicine,DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction: Graves’ disease is the most common cause of hyperthyroidism in the United States. Management regimens include anti-thyroid medication, radioiodine ablation and thyroidectomy. Whereas patient preference and clinical features such as compressive symptoms, intolerance or intractability to medical treatment, and ophthalmopathy are known reasons for thyroidectomy, demographic and socioeconomic factors may also influence the decision for surgical treatment. This study examines the influence of these aforementioned factors in the use of thyroidectomy during hospitalizations for Graves’ disease.
Methods: A cross-sectional analysis was performed using the Nationwide Inpatient Sample (2006-2011) to identify hospitalizations for Graves’ disease. Patient demographic, socioeconomic, and clinical factors including thyroidectomy during hospitalization were assessed. Bivariate and logistic regression analyses were performed to identify characteristics independently predictive of undergoing thyroidectomy during hospitalization for Graves’ disease. Factors associated with non-elective hospitalizations were also evaluated.
Results: Of 33,279 patients admitted for Graves’ disease during the study period, 10,434 (31.4%) underwent total thyroidectomy. Majority of thyroidectomies (84.8%) were performed during elective admissions. Patients in the thyroidectomy group were younger than the non-surgical cohort (mean 40.1 vs. 42.5 years, respectively). This surgical group also had higher proportion of women (83.7% vs. 75.6%, p<0.01) and whites (59.1% vs 42.0, p<0.01) compared to the non-surgical group. Most thyroidectomy patients were covered by Medicare or private insurance (69.8% vs. 48.8%, p<0.01) with a preponderance of patients from the two highest income quartiles (50.3% vs. 38.4%, p<0.01) compared to non-surgical patients, respectively. On multivariate analysis, female sex (OR 1.52; 95% CI 1.37-1.69), white race (OR 1.27; 95% CI 1.17-1.39), Medicare/insured (OR 1.23; 95% CI 1.12-1.35), and highest income quartile (OR 1.28; 95% CI 1.14-1.45) were associated with increased odds of undergoing thyroidectomy during hospitalization for Graves’ disease. In contrast, male sex (OR 1.26; 95% CI 1.14-1.39), non-white race (OR 1.49; 95% CI 1.38-1.62), Medicaid/uninsured (OR 2.53, 95% CI 2.32-2.75), and lowest income quartile (OR 1.30; 95 CI 1.16-1.50) were associated with higher risk for emergency hospitalizations for Graves’ disease.
Conclusion: In the United States, demographic and socioeconomic characteristics may influence utilization of thyroidectomy for definitive treatment of hospitalized patients with Graves’ disease. Rate of emergent hospital admissions for Graves’ disease is also influenced by race, sex, income, and insurance status. Interventions to increase access for definitive care for Graves’ disease in these patients may lower rate of adverse outcomes and emergency healthcare utilization.