Sosa Julie Ann, Tuggle Charles T, Wang Tracy S, Thomas Daniel C, Boudourakis Leon, Rivkees Scott, Roman Sanziana A
Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, Wisconsin 53226, USA.
J Clin Endocrinol Metab. 2008 Aug;93(8):3058-65. doi: 10.1210/jc.2008-0660. Epub 2008 Jun 3.
Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes.
The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy.
This study is a cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample hospital discharge information from 1999-2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes.
Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy.
Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs.
The majority of patients were female (76%), aged 13-17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0-6 yr had higher complication rates (22% vs. 15% for 7-12 yr and 11% for 13-17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7-12 yr and 1.8 for 13-17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01).
Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.
成人甲状腺切除术/甲状旁腺切除术后的临床和经济结果显示，基于患者年龄和种族/民族存在差异；关于儿科内分泌结果的文献较少。
本研究旨在探讨儿科甲状腺切除术/甲状旁腺切除术后结果的临床和人口统计学预测因素。
本研究是对1999 - 2005年医疗成本与利用项目 - 国家住院样本医院出院信息的横断面分析。纳入所有接受甲状腺切除术/甲状旁腺切除术的患者。进行双变量和多变量分析以确定患者结果的独立预测因素。
研究对象包括1199例17岁及以下接受甲状腺切除术/甲状旁腺切除术的患者。
观察指标包括住院患者并发症、住院时间（LOS）和住院费用。
大多数患者为女性（76%），年龄在13 - 17岁（71%），且为白人（69%）。白人更常属于高收入群体（80%，西班牙裔为8%，黑人为6%；P < 0.01），拥有私人/健康维护组织保险（76%，西班牙裔为10%，黑人为5%；P < 0.001），而非医疗补助保险（13%，西班牙裔为32%，黑人为41%；P < 0.001）。91%的手术为甲状腺切除术，9%为甲状旁腺切除术。0 - 6岁儿童的并发症发生率更高（22%，7 - 12岁儿童为15%，13 - 17岁儿童为11%；P < 0.01），住院时间更长（3.3天，7 - 12岁儿童为2.3天，13 - 17岁儿童为1.8天；P < 0.01），费用也更高。与高收入家庭的儿童相比，低收入家庭的儿童并发症发生率更高（11.5%对7.7%；P < 0.05），住院时间更长（2.7天对1.7天；P < 0.01），费用更高。甲状旁腺切除术后儿童的内分泌特异性并发症发生率高于成人（15.2%对6.2%；P < 0.01），甲状腺切除术后也是如此（9.1%对6.3%；P < 0.01）。
接受甲状腺切除术/甲状旁腺切除术的儿童并发症发生率高于成年患者。由高手术量的外科医生进行手术时，结果得到优化。低收入家庭的儿童、黑人和西班牙裔儿童在获得高手术量外科医生治疗方面似乎存在差异。
