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Original Investigation
October 12, 2017

Nationwide Variation in Rates of Thyroidectomy Among US Medicare Beneficiaries

Author Affiliations
  • 1Division of Otolaryngology, Wisconsin Surgical Outcomes Research Group, Department of Surgery, University of Wisconsin, Madison
  • 2Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston
  • 3Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 4The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
  • 5Section of Otolaryngology in Geisel School of Medicine at Dartmouth, White River Junction, Vermont
  • 6The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire
JAMA Otolaryngol Head Neck Surg. Published online October 12, 2017. doi:10.1001/jamaoto.2017.1746
Key Points

Question  To what degree do thyroidectomy rates vary among Medicare beneficiaries across US regions?

Findings  In this cross-sectional study of 15 888 thyroidectomies performed on Medicare beneficiaries in 2014, there was a 6.2-fold difference in thyroidectomy rates was observed across US regions among Medicare beneficiaries.

Meaning  Wide variation in thyroidectomy rates observed among Medicare beneficiaries suggests widely divergent local beliefs and practice patterns surrounding the management of thyroid nodules and cancer because rates appeared to be unrelated to health care availability, regional socioeconomic status, or surgeons per capita.

Abstract

Importance  Research on variation in rates of procedures across otherwise similar geographic regions provides vital insight into practice patterns. It reveals the degree of consensus on how a particular condition is managed, shows areas where access to care may be inadequate, and other areas where the population may be receiving inappropriately high levels of care.

Objective  To test the hypothesis that rates of thyroid surgery vary across US geographic regions

Design, Setting, and Participants  A cross-sectional analysis of Medicare data for 15 888 beneficiaries aged 65 years or older from 2014 was carried out.

Main Outcome  Overall and hospital referral region-specific thyroidectomy rate per 100 000 Medicare beneficiaries.

Results  In 2014, 15 888 thyroidectomies were performed on Medicare beneficiaries in the United States (partial n = 7506, total n = 8382), representing a national average rate of 60 per 100 000 beneficiaries (median, 59 per 100 000 beneficiaries; IQR, 43-70 per 100,000). A 6.2-fold difference in thyroidectomy rates was observed across US regions (range, 22-139 per 100 000 Medicare beneficiaries).

Conclusions and Relevance  Thyroidectomy rates in the United States vary 6.2 fold, more than prostatectomy rates, which are usually held as the example of the procedure with the widest variation in the United States. This wide variation in thyroidectomy rates observed among Medicare beneficiaries suggests widely divergent local beliefs and practice patterns surrounding the management of thyroid nodules and cancer because rates appeared to be unrelated to health care availability, regional socioeconomic status, or surgeons per capita. A better understanding for the reasons underlying this variation is needed.

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