(A311) Racial and Regional Disparities in Parathyroidectomy: A National Analysis of Ambulatory Surgery Centers

Introduction: Parathyroidectomy (PTx) is performed disproportionately more frequently in White patients despite evidence of higher incidence of hyperparathyroidism in Black patients. Few studies have characterized national and regional differences in PTx at ambulatory surgery centers. We aim to assess the national and regional PTx volume and predictors of White vs non-White PTx.

Methods: The Nationwide Ambulatory Surgery Sample (NASS) was used to identify patients undergoing primary PTx from 2019-2021. Patient demographics, and hospital characteristics (teaching status, geographic region, urban/rural location, etc) were evaluated. Chi-squared tests were used to compare proportions. T- vs Mann-Whitney U tests were used for continuous variables. A sample-weighted logistic regression model was performed adjusting for variables including patient demographics, comorbidities, and hospital characteristics.

Results: Of ~36.2 million patients, a weighted total of 120,944 patients were included with overall higher case volume in White (n=89,628, 74.1%) versus non-White individuals (n=31,316, 25.9%). Most PTx were performed at urban/teaching centers (84.8%) and in the Southern region (39.5%). Non-white patients were younger (58.5 vs 63.1 P < 0.001) with higher Elixhauser comorbidity scores (1.71 vs 1.55, P < 0.001) and incurred greater total charge ($44,224 vs $36,955, P < 0.001). Adjusted multivariate regression identified that PTx recipients were less likely to be non-White in the Midwest (OR 0.46 [0.371-0.573] P < 0.001), while odds were equivocal in other regions.

Conclusions: National disparities in PTx surgery persist at ambulatory centers. Non-white patients present younger and with more comorbidities and leave with greater total charge. The greatest opportunity for improvements in treatment equity are in the Midwest.