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Clinical and Economic Outcomes of Thyroid and Parathyroid Surgery in Children

Departments of Surgery (J.A.S., C.T.T., D.C.T., L.B., S.A.R.) and Pediatrics (S.R.), Yale University School of Medicine, New Haven, Connecticut 06510; and Department of Surgery (T.S.W.), Medical College of Wisconsin, Milwaukee, Wisconsin 53226

Address all correspondence and requests for reprints to: Tracy S. Wang, M.D., M.P.H., Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226. E-mail: tswang{at}mcw.edu.

Context: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes.

Objective: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy.

Design: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project–National Inpatient Sample hospital discharge information from 1999–2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes.

Subjects: Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy.

Main Outcome Measures: Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs.

Results: The majority of patients were female (76%), aged 13–17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0–6 yr had higher complication rates (22% vs. 15% for 7–12 yr and 11% for 13–17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7–12 yr and 1.8 for 13–17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01).

Conclusions: Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.