C. Gibson1, A. Chiu1, R. Maduka1, R. Jean1, N. Wills-Johnson1, S. Abou Azar1, K. Oliveira1, V. Ahuja1 1Yale University School Of Medicine,New Haven, CT, USA
Introduction:
Surgery for benign thyroid disease encompasses a significant proportion of endocrine surgery operations. While racial disparities in outcomes of surgery for thyroid cancer has been proven, disparities for benign disease have not been previously characterized. We hypothesize that minority groups have higher incidence of post-operative complications following total and partial thyroidectomy for non-malignant disease.
Methods:
All adult patients (>17 years) undergoing thyroid surgery for an indication other than malignancy were identified in the NSQIP Thyroidectomy targeted database between 2016-2017. Surgical indications included Graves’ disease, goiter, adenoma, and “other benign nodule” (Hashimoto’s thyroiditis, hyperplastic nodule, colloid nodule, pseudonodule, trabecular adenoma). Primary outcomes of interest included rate of neck hematoma, recurrent laryngeal nerve (RLN) injury, and clinically significant hypocalcemia within 30 days. Univariate and multivariate logistic regression models were performed to analyze the association between these complications and patient race. Multivariate models controlled for patient age, gender, indication for surgery, history of neck surgery, ASA class, and type of operation (partial thyroidectomy, total thyroidectomy, or thyroidectomy with extended dissection).
Results:
A total of 6,817 patients were identified in the NSQIP database, of which 55.0% were non-Hispanic white, 20.1% were black, 4.6% Hispanic, 4.2% Asian, and 16.2% other/unknown. The most common indication for surgery was goiter (65.2%), followed by adenoma (11.2%), other benign nodule (10.2%), Graves’ disease (9.7%), and severe goiter (3.8%).
Overall, 2.0% of patients had a postoperative neck hematoma, 5.2% had a RLN injury, and 4.9% had significant hypocalcemia. Controlling for demographic and clinical factors, black patients were associated with greater odds of neck hematoma (OR 2.32, 95%CI 1.51-3.55) and RLN injury (OR 1.97, 95%CI 1.53-2.55) compared to white patients. Asian patients also had significantly greater odds of RLN injury (OR 1.88, 95%CI 1.15-3.06) compared to white patients. Hispanic patients had similar outcomes to white patients; however, they trended towards greater odds of postoperative hypocalcemia (OR 1.42, 95%CI 0.89-2.28).
Conclusion:
Minority patients are more likely than white patients to have significant postoperative complications following surgery for benign thyroid disease. This disparity in outcomes is similar to findings of malignant thyroid disease, indicating broader racial disparities in the surgical treatment of endocrine disease.
