Variation in Thyroidectomy Use in Low-Risk Thyroid Cancer: Analysis of a Statewide Claims Registry

Abstract

Introduction Studies have shown variation in thyroidectomy use across geographic settings but have not examined statewide, procedure-specific (total thyroidectomy [TT] versus thyroid lobectomy [TL]) rates for thyroid cancer at the surgeon or facility level. This study aimed to characterize variation and trends across hospitals at the surgeon and facility levels in utilization of TT and TL for low-risk thyroid cancer. Methods This retrospective cohort study analyzed adults who underwent thyroidectomy for thyroid cancer in a statewide claims registry (2015-2022). Patients receiving radioactive iodine <180 days after thyroidectomy were excluded to identify low-risk cancers. Analyses examined variation in TT rates using mixed-effect models with random clustering effect by surgeon or facility. Poisson regression evaluated thyroidectomy trends. Results Of 2615 patients (75.3% female; 56.8 ± 15.2 y old) treated by 297 surgeons across 80 facilities, 1741 (66.6%) underwent TT, while 874 (33.4%) underwent TL. Wide variation existed in TT use at the surgeon (38%-87%) and facility- (51%-80%) levels. At the surgeon level, Medicare beneficiaries were more likely to undergo TT (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.04-1.77) compared to other insurance types, while patients treated by an otolaryngologist were less likely (OR 0.57, 95% CI 0.40-0.81) compared to general surgeons. At the facility level, male patients were less likely to undergo TT (OR 0.81, 95% CI 0.66-0.98). From 2015 to 2022, annual TL rates doubled (22.5%-40.9%; P < 0.001), TT rates decreased (68.4%-50.9%; P = 0.047), and completion thyroidectomy rates remained stable ( P = 0.75). Conclusions Significant variation exists in utilization of TT for low-risk thyroid cancer with increasing TL rates. Opportunities to intervene at the surgeon level to reduce variation and decrease TT use are most actionable.