R. Zheng1, A. Rios-Diaz1, D. P. Thibault2, J. A. Crispo2, A. Willis2, A. I. Willis1 1Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 2University Of Pennsylvania,Department Of Biostatistics And Epidemiology,Philadelphia, PA, USA
Introduction:
Although iodine deficiency is a known cause of goiter worldwide, there is a paucity of information regarding people undergoing operations for simple, iodine-deficiency-related goiters in the U.S. Our study aimed to determine the current distribution of etiologies of goiters undergoing thyroidectomy in the U.S., and to identify disparities among those most at risk for simple goiters (SG).
Methods:
The National Inpatient Sample (NIS) database was queried to identify hospitalizations of individuals who underwent complete or partial thyroidectomy in years 2009-2013, using International Classification of Diseases, Ninth Revision, Clinical Modification codes to classify hospitalizations by goiter subtype. Descriptive statistics were used to analyze patient- and facility-level factors by chi square. Multivariable logistic regression models were used to determine factors associated with the development of SG requiring thyroidectomy.
Results:
We identified 103,678 hospitalizations for thyroidectomy: 58,313 total; 38,433, partial; 6,391, substernal. SG diagnosis was coded in 7,692 (7.42%); nodular goiter, 73,524 (70.92%); thyrotoxicosis, 14,043 (13.54%); thyroiditis, 1,248 (1.20%); and thyroid cancer, 7,169 (6.92%). Significant differences were demonstrated by chi square across patient-level categories comparing goiter subtypes (p<0.05). Notably, Whites had their highest frequency among thyroiditis, Blacks had their highest frequency among SG. Patients aged > 65 years had their highest frequency among SG while <45 had their highest frequency among thyrotoxicosis. Women predominated overall, but men had their highest frequency among SG closely followed by cancer. Medicare patients’ highest frequency was among SG, which was the lowest frequency diagnosis for privately insured patients. Patients in the <25th income percentile had their highest frequency among SG, which was the lowest for 51-75th and 76-100th percentiles. Hospitals in the South had their highest frequency among SG, while those in the Northeast had their highest frequency among cancer. Multivariable adjusted logistic regression models found the factors associated with operation for SG were: age > 65 (AOR 1.82 [CI 1.45-2.27]) and 45-65 (AOR 1.34 [1.15-1.55]), black race (AOR 1.38 [1.18-1.62]), self-pay (AOR 1.96 [1.42-2.69]), hospital location in the South (AOR 1.5 [1.15-1.96]) and Midwest (AOR 1.53 [CI 1.15-2.05]). Odds were decreased for women (AOR 0.69 [0.6-0.8]); incomes 26th-50th % (AOR 0.82 [0.7-0.97]), 51st-75th % (AOR 0.67 [0.56-0.82]), and 76th-100th % (AOR 0.64 [90.5-0.82]).
Conclusion:
This study elucidates distributions within goiter types undergoing thyroidectomy in the U.S. SG associated with iodine-deficiency remains a national issue that is disproportionately found in patients who are older, poorer, of black race, or are treated in the South and Midwest. Identifying these risk factors may allow for targeted efforts to reduce SG nationwide.