The Relationship Between Hospital Safety-Net Burden on Outcomes for High-Volume Thyroid Cancer Surgeons.

IF 5.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Thyroid Pub Date : 2024-11-11 DOI:10.1089/thy.2024.0268
Hattie H Huston-Paterson, Yifan V Mao, Chi-Hong Tseng, Jiyoon Kim, Debbie W Chen, James X Wu, Michael W Yeh
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Abstract

Background: Higher center and surgeon volume correspond to better outcomes for patients with thyroid cancer. This study aims to investigate how a hospital's safety-net burden, the proportion of a hospital's patients who are insured by state Medicaid plans or are uninsured, influences the outcomes of high-volume (HV) surgeons. Methods: We performed a retrospective cohort study of all patients who underwent surgery for thyroid cancer in California from 1999 to 2017. We stratified treating facilities by the proportion of Medicaid-type and indigent payors into safety-net burden quartiles. We compared the perioperative and oncologic outcomes of HV surgeons (annual case volume ≥10) for patients undergoing total thyroidectomy across safety-net burden quartiles. A mixed-effects regression model controlled for surgeon random effects and fixed effects of patient and tumor characteristics. Results: Our sample comprised 42,347 patients (78% female, median age 50), of whom 13,848 (32%) were treated by HV surgeons (n = 276). Compared to patients of lower-volume surgeons, patients of HV surgeons were more likely to be White, from the upper quartiles of socioeconomic status and well insured (all p < 0.001). HV surgeons in each hospital's safety-net burden quartile displayed similar case number distributions. Compared to patients treated by HV surgeons at Q1 (lowest safety-net burden) hospitals, those treated by HV surgeons at Q4 (highest safety-net burden) hospitals had higher absolute risks of endocrine complications (+7%, p = 0.007), airway complications (+6%, p = 0.004), disease-specific mortality (+1.3%, p = 0.046), and all-cause mortality during the study period (+3%, p = 0.046) in multivariable analysis. Conclusion: The performance of HV thyroid cancer surgeons differs by a hospital's safety-net burden, with patients treated at high safety-net burden hospitals experiencing higher rates of operative complications, disease-specific mortality, and all-cause mortality. Having a HV surgeon alone may be insufficient to provide optimal short- and long-term outcomes for patients with thyroid cancer.

医院安全网负担与大量甲状腺癌外科医生的治疗结果之间的关系。
背景:对于甲状腺癌患者而言,中心和外科医生数量越多,治疗效果越好。本研究旨在探讨医院的安全网负担(即医院中参加州医疗补助计划或未参加医疗补助计划的患者比例)如何影响高手术量(HV)外科医生的治疗效果。方法:我们对 1999 年至 2017 年在加利福尼亚州接受甲状腺癌手术的所有患者进行了一项回顾性队列研究。我们按照医疗补助类型和贫困支付者的比例将治疗机构划分为安全网负担四分位。我们比较了不同安全网负担四分位数的HV外科医生(年病例量≥10)为接受全甲状腺切除术的患者提供的围手术期和肿瘤治疗效果。混合效应回归模型控制了外科医生的随机效应以及患者和肿瘤特征的固定效应。结果:我们的样本包括 42,347 名患者(78% 为女性,中位年龄为 50 岁),其中 13,848 人(32%)接受了高风险外科医生的治疗(n = 276)。与就诊量较低的外科医生的患者相比,HV 外科医生的患者更可能是白人、来自社会经济地位较高的四分位数且有良好的保险(均 p < 0.001)。在每家医院的安全网负担四分位数中,HV 外科医生的病例数分布相似。在多变量分析中,与第一季度(安全网负担最低)医院的 HV 外科医生治疗的患者相比,第四季度(安全网负担最高)医院的 HV 外科医生治疗的患者发生内分泌并发症(+7%,p = 0.007)、气道并发症(+6%,p = 0.004)、疾病特异性死亡率(+1.3%,p = 0.046)和研究期间全因死亡率(+3%,p = 0.046)的绝对风险更高。结论HV甲状腺癌外科医生的表现因医院的安全网负担而异,在安全网负担高的医院接受治疗的患者的手术并发症发生率、疾病特异性死亡率和全因死亡率都较高。仅有一名HV外科医生可能不足以为甲状腺癌患者提供最佳的短期和长期治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Thyroid
Thyroid 医学-内分泌学与代谢
CiteScore
12.30
自引率
6.10%
发文量
195
审稿时长
6 months
期刊介绍: This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.
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