M. Kheng1, A. Manzella1, A.M. Laird1,2, T. Beninato1,2 1Rutgers Robert Wood Johnson Medical School, General Surgery, New Brunswick, NJ, USA 2Rutgers Cancer Institute of New Jersey, Section Of Endocrine Surgery, New Brunswick, NJ, USA
Introduction: Significant disparities exist in access to high-volume endocrine surgeons across the United States. Regional differences, however, have not been well-characterized; in this study we investigated thyroidectomy volume patterns and complication rates across the country.
Methods: We queried the Vizient Clinical Data Base for patients who underwent either thyroid lobectomy or total thyroidectomy for both benign and malignant disease from 2013-2021. Surgeons with 4+ years of operative data were grouped based on average annual thyroidectomy volume into low (1-24 cases), medium (25-49 cases), high (50-99 cases), and very high volume (100+ cases). States were categorized into eight divisions: New England, Mideast, Great Lakes, Plains, Southeast, Southwest, Rocky Mountains, and Far West.
Results: In total, 295,154 operations were performed by 3,013 surgeons. Average annual case volumes ranged from 1-452 cases. The greatest number of operations were performed on patients living in the Southeast (23.6%), followed by Mideast (20.5%), Great Lakes (18.8%), Far West (11.3%), New England (8.8%), Plains (7.4%), Southwest (7.2%), and Rocky Mountains (2.4%) (p<0.001). Low-volume surgeons performed the majority of cases in all regions, ranging from 23.5% of cases in New England to 44.0% in the Rocky Mountains (p<0.001). The proportion of cases performed by high-volume surgeons ranged from 17.1% in the Southwest to 35.2% in the Southeast.
Very-high volume surgeons performed the largest proportion of operations in New England (35.0%) and the fewest in the Rocky Mountains (0.7%). Collectively, high and very high volume surgeons performed 51.7-59.7% of cases in the Southeast, Mideast, and New England. Conversely, they performed 28.3-39.1% of cases in the Rocky Mountains, Southwest, and Plains. Nationally, complication rates were highest for low-volume surgeons (2.2%), followed by medium-volume (1.4%) and high-volume surgeons (1.3%); very high-volume surgeons had the lowest rates (0.2%) (p<0.001).
Conclusion: Across the United States, the majority of thyroidectomies continue to be performed by low-volume surgeons. However, significant regional differences exist, with a greater proportion of patients in the Eastern regions of the country receiving surgical care from higher-volume surgeons. Disparities in access to high-volume surgeons may translate to differences in perioperative outcomes for patients undergoing thyroidectomy.