Inpatient total thyroidectomy costs and outcomes vary regionally: A nationwide study

Objectives: While it is known that surgical costs continue to rise in the United States, there is little information about the specific underlying factors for this variation in many common procedures. This study investigates the influence of geographic location and hospital demographics on hospital cost and postoperative outcomes in adult patients undergoing total thyroidectomy (TT).

Methods: The National Inpatient Sample was queried for patients who underwent primary TT between 2016 and 2017. Multivariable analyses were conducted to determine estimates and odds ratios (OR) between various hospital factors and total cost, prolonged length of stay (LOS), and non-home discharge. Reference categories were small bed-size and Northeast region.

Results: A weighted total of 16,880 patients with mean age of 50.6 years were included. Most patients were female (73.8%), White (57.0%), and treated at Southern (32.4%), large bed-size (65.1%), and urban teaching (82.7%) hospitals. Medium and large bed-size hospitals were associated with a 6.5% (p < .001) and 7.5% (p < .001) reduction in TT cost, respectively. TT cost was greatest in the West, associated with a 32.4% increase (p < .001). Patients in the Midwest (OR 1.366, p = .011) had prolonged LOS, whereas patients treated in the Midwest (OR 0.436, p < .001), South (OR 0.438, p < .001), and West (OR 0.502, p < .001) had lower odds of non-home discharge.

Conclusion: There is geographic variation in both costs and outcomes of TT. Although Northeastern hospitals had the lowest costs for TT, they were associated with the greatest odds for non-home discharge.Level of evidence: IV.