Abstract Background For patients with Graves’ undergoing surgery, the American Thyroid Association guidelines recommend referral to a high-volume thyroid surgeon (HVTS). However, factors limiting patient utilization of a HVTS are poorly understood. This study aimed to identify factors associated with utilization of a HVTS for patients with Graves’. Methods This retrospective cohort study analyzed adults with Graves’ who underwent thyroidectomy from January 2015 to December 2022 in a statewide claims registry. Surgeons were categorized as high-volume (25 thyroidectomies/year) or low-volume (LVTS; ≤25 thyroidectomies/year). Logistic regression evaluated patient demographics, travel distance to treating HVTS-hospital and closest endocrinologist, household income, area deprivation index, and education. Results Among 764 patients treated by 130 surgeons, 17 HVTS performed the majority (60.4%) of thyroidectomies. Most patients were female (84.3%) and White (51.0%). Patients treated by a HVTS travelled 16.8 miles farther (p0.001). On multivariable analysis, distance travelled to the treating hospital (OR 1.01, 95% CI 1.003-1.014) and education of a patient’s home zip code (OR 0.87, 95% CI 0.83-0.91) were significant predicators of utilizing a HVTS. Proximity to an endocrinologist was not associated with utilization (p=0.45). Surgery by a HVTS was associated with lower rates of hypocalcemia (18.2% vs. 24.8%, p=0.03) and cardiac events (10.4% vs. 17.2%, p=0.008). Conclusion Just over half of patients with Graves’ disease received guideline-concordant surgical care by a HVTS. Enhancing patient knowledge and awareness of the benefits of HVTS care and solving transportation barriers may improve patients with Graves’ utilization of HVTS and outcomes.
Xie et al. (Tue,) studied this question.