Trends for In- and Outpatient Thyroid Cancer Surgery in Older Adults in New York State, 2007-2017

Background: In view of the 2013 American Thyroid Association consensus statement on outpatient thyroidectomy, the present study assessed the trends and factors associated with thyroid cancer surgery setting in older adults, using the New York Statewide Planning and Research Cooperative System database. Materials and methods: There were 14,495 patients with surgically treated thyroid cancer in New York State between 2007 and 2017. Trends were plotted over time and stratified by surgery type. Significance of the trend was assessed using the Mann-Kendall test. Multivariable logistic regression was used to assess independent associations with surgical setting. Results: The overall outpatient surgery rate significantly increased over time (correlation coefficient 0.82; P < 0.001), for both total thyroidectomy (P < 0.001) and lobectomy (P < 0.001). Factors associated with increased odds of inpatient surgery were medium- and high-volume hospitalization (adjusted odds ratio [OR_adj] 2.12, 95% confidence interval [CI] 1.93-2.32; OR_adj 1.69, 95% CI 1.55-1.85, respectively) versus low volume, undergoing total thyroidectomy (OR_adj 1.75, 95% CI 1.61-1.90), as well as having Medicare insurance (OR_adj 1.13, 95% CI 1.02-1.24) versus private insurance. Conclusions: The present study shows that outpatient thyroidectomy is increasingly favored over inpatient thyroidectomy over time in an older patient population. A clear changepoint following 2011 preceded the publication of the American Thyroid Association statement on outpatient thyroidectomy in 2013 and was likely associated with multiple publications reporting safety of outpatient thyroid surgery and clear economic benefits.