Disparities in Utilization of High-Volume Thyroid Surgeons for Graves’ Disease: A Statewide Analysis

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 (p<0.001). 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.