Factors Associated with Receiving Thyroid Cancer Care From High-Volume Surgeons: Analysis of a State-Wide Claims Registry.

Abstract

High-volume thyroid surgeons (HVTSs) provide quality care with fewer adverse outcomes, yet access to these surgeons can be challenging. This study aimed to assess factors associated with receiving care from an HVTS for thyroid cancer. This retrospective cohort study analyzed adults with thyroid cancer who underwent thyroidectomy in a state-wide multipayor claims registry (2015 to 2022). Surgeons were classified as high (greater than 25 per year) or low volume (25 per year or less; LVTS). Logistic regression evaluated demographics; distance between home, surgical facility, and closest endocrinologist; and ZIP code-level census data in association with surgery by an HVTS. Overall, 357 surgeons performed thyroidectomies on 3,839 patients with thyroid cancer: 17 (4.8%) were HVTS and 340 (95.2%) were LVTS. Most thyroidectomies were performed by LVTS (53.9%, 2,068). Patients treated by HVTS traveled an average of 4.8 miles farther to their treating surgeons (33.7 ± 44.4 miles vs 28.9 ± 44.3 miles to LVTS, p < 0.001). Factors significantly (p < 0.05) associated with an increased likelihood of treatment by an HVTS included: having Medicare Advantage through a preferred provider organization and living further from their treating surgeon. Patients who were significantly (p < 0.05) less likely to have surgery by an HVTS were male, had Medicare insurance without an advantage plan, lived in a ZIP code with low educational attainment, and lived further from an endocrinologist. This study identified several factors independently associated with decreased odds of having thyroidectomy by an HVTS for thyroid cancer treatment in the state of Michigan. These results underscore the continued existence of inequities in access within our healthcare system.