In:
The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 93, No. 8 ( 2008-08-01), p. 3058-3065
Abstract:
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 & lt; 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P & lt; 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P & lt; 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 & lt; 0.01), LOS (3.3 d vs. 2.3 for 7–12 yr and 1.8 for 13–17 yr; P & lt; 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 & lt; 0.05), longer LOS (2.7 vs. 1.7 d; P & lt; 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P & lt; 0.01) and thyroidectomy (9.1 vs. 6.3%; P & lt; 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.
Type of Medium:
Online Resource
ISSN:
0021-972X
,
1945-7197
DOI:
10.1210/jc.2008-0660
Language:
English
Publisher:
The Endocrine Society
Publication Date:
2008
detail.hit.zdb_id:
2026217-6
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