SUN-398 Disparities in Access to High-Volume Surgeons for Graves’ Disease: A Statewide Analysis

Abstract Disclosure: S. Xie: None. C.B. Jensen: None. A. Sinha: None. E.M. Bacon: None. L.N. Krumeich: None. H.J. Underwood: None. D.T. Hughes: None. P.G. Gauger: None. M.J. Englesbe: None. S. Pitt: None. Background: For patients with Graves’ disease who undergo surgery, the American Thyroid Association guidelines recommend total thyroidectomy by high-volume thyroid surgeons (HVS). However, little is known about factors that limit Graves’ patients access to HVS. This study aimed to identify factors contributing to disparities in accessing HVS for Graves’ disease patients. Methods: This retrospective cohort study analyzed adults ≥ 18 years-old with Graves’ disease who underwent thyroidectomy from January 2015-December 2022 in a statewide claims registry. Surgeons were categorized as high- (>25 thyroidectomies/year) or low-volume (LVS; ≤25 thyroidectomies/year). Logistic regression was used to evaluate patient demographics, distance between home and HVS-hospital zip code and closest endocrinologist, household income, area deprivation index (ADI; higher index representing more deprivation), and education in relation to accessing HVS. Results: Overall, 135 surgeons performed thyroidectomies on 806 patients; 17 were HVS (12.6%) and performed 60.4% of the surgeries. On univariate analysis, factors associated with reduced access to HVS included older patient age (51.4±15.3 vs. 48.7±15.2 years, p=0.01), Medicare insurance (28.5% vs. 19.9%, p=0.04), greater travel distance to HVS-hospital (42.0±97.6 vs. 25.6±45.3 miles, p<0.001), higher ADI (6.4±2.9 vs. 4.7±3.0, p<0.001), and lower education levels (high school dropout rate: 6.4±3.5% vs. 4.8±3.1%, p<0.001). Proximity to an endocrinologist was not associated with access to HVS (15.5±54.1 miles to endocrinologist treated by HVS vs. 17.9±32.9 miles to endocrinologist treated by LVS, p=0.42). On regression analysis, patients who were older (OR 0.99, 95% CI 0.97-0.99), lived farther from HVS-hospital (OR 1.01, 95% CI 1.00-1.02), and had lower education levels (OR 0.86, 95% CI 0.83-0.91; Figure 1) were less likely to access HVS. Surgeon volume was not associated with outcomes of vocal cord dysfunction, hypocalcemia, and bleeding. However, treatment by HVS was associated with lower rates of cardiac events (11.1% vs. 16.6%, p=0.03) and cerebrovascular complications (0% vs. 2.2%, p <0.003). Conclusion: Just over half of patients with Graves’ disease (60.4%) received guideline-concordant surgical care by HVS in our study. While older age and lower education are unmodifiable barriers to access, distance travelled to HVS-hospital is potentially modifiable. Enhancing patients’ awareness of HVS benefits and leveraging ongoing hospital consolidations present opportunities to improve access to HVS and outcomes for patients with Graves’ disease. Presentation: Sunday, July 13, 2025