This study showed pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance and access to high-volume surgeons.
Most thyroid and parathyroid disease occurs in women, with a significant proportion during the childbearing years. During pregnancy, these endocrine disorders pose significant risks to both mother and fetus if left untreated. Yet evidence in the published literature is poor on both outcomes for thyroid and parathyroid procedures as well as effective practice guidelines. This is the first population-based study to examine predictors of clinical and economic outcomes following thyroid and parathyroid procedures in pregnant women. It is a retrospective cross-sectional study of 201 pregnant women, compared with nonpregnant women, who underwent procedures from 1999 to 2005 in a 20 percent sample of nonfederal U.S. hospitals.
- Pregnant women had higher complication rates, longer length of stay (LOS), and higher hospital costs than similar nonpregnant women.
- Pregnant women had maternal and fetal complication rates of 4.5 percent and 5.5 percent, respectively.
- Higher surgeon volume was a predictor of lower complication rates and shorter LOS; not being white and having government insurance predicted higher complication rates and longer LOS.
Whenever possible, pregnant women undergoing thyroid and parathyroid procedures should be directed to high-volume surgeons, and disparities in outcomes based on race and insurance must be overcome.