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Submitted on March 24, 2008
Accepted on May 22, 2008
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
* To whom correspondence should be addressed. 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 following 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: 1,199 patients 
17 years undergoing thyroidectomy/parathyroidectomy.
Main outcome measure: In-hospital patient complications, length of stay (LOS), and inpatient hospital costs.
Results: The majority of patients were female (76%), aged 13–17 years (71%), and white (69%). Whites were more often in the highest income group (80% vs. 8%Hispanic, 6%black;P<0.01) and had private/HMO insurance (76% vs. 10%Hispanic, 5%black;P<0.001) rather than Medicaid (13% vs. 32%Hispanic, 41%black;P<0.001). 91% of procedures were thyroidectomies, 9% parathyroidectomies. Children aged 0–6 years had higher complication rates (22% vs. 15% 7–12years, 11% 13–17years;P<0.01), LOS (3.3days vs. 2.3, 7–12years, 1.8, 13–17years;P<0.01), and higher costs. Compared to children from higher income families, those from lower income families had higher complication rates (11.5% vs. 7.7%;P<0.05), longer LOS (2.7days vs. 1.7;P<0.01), and higher costs. Children had higher endocrine-specific complication rates than adults following 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.
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