Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018

Citation:

Toumi A, DiGennaro C, Vahdat V, Jalali MS, Gazelle SG, Chhatwal J, Kelz RR, Lubitz CC. Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018. Thyroid 2020;
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018

Abstract:

Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.

Last updated on 12/17/2020