Thyroid cancer surgery in Germany

Abstract

In 2004, a Diagnosis Related Groups (DRG)-based hospital reimbursement system became mandatory in Germany. The aim of this study was to provide nationwide data on the surgery of thyroid cancer by analyzing DRG statistics of the years 2005 and 2006. The unit of analysis was hospital admission with a diagnosis of thyroid cancer. We assessed the influence of age, sex and region on the relative frequency of thyroid cancer-related hospitalisations with surgery of the thyroid and we measured the association between hospitalisation rates and incidence rates of thyroid cancer among the Federal States of Germany. Over the period 2005 to 2006, 11,107 thyroid cancer-associated hospitalisations included surgical treatment of the thyroid. The age-standardised DRG-based hospitalisation rates and the corresponding cancer registry-based incidences of thyroid cancer were positively associated. Overall, 68% of the hospitalisations with thyroid surgery included a total thyroidectomy. The percentage of surgery of the thyroid with a total thyroidectomy was nearly identical among men and women, decreased among men aged over 60 and varied considerably by region (minimum, 48% in Saarland; maximum, 78% in Saxony-Anhalt). Our analyses of DRG statistics provide for the first time representative population-based data of the surgical management of thyroid cancer patients in Germany. Despite an identical health care system all over Germany and existing guidelines for surgical treatment of thyroid cancer, we observed a considerable regional variation in the proportion of total thyroidectomies performed in Germany.