Comprehensive Surgical Thyroid Management in a Rural Health System During the Global Pandemic

ABSTRACT

Introduction: Access to high-quality, comprehensive, subspecialty care is challenging in rural health care settings under ideal circumstances. In the clinically restricted environment created by the SARS-CoV-2 pandemic, this has been even more problematic. The regional distribution of a broad patient demographic across multiple tertiary care centers within a large rural health care system presents unique challenges. Here we describe our system platform for the management of a large population of thyroid patients across an expansive rural health system during the pandemic. Method(s) This retrospective review was approved by our institutional review board. Patients undergoing surgical management of thyroid and parathyroid disease were identified using a system electronic medical record via Current Procedural Terminology codes. Applications essential for management of these patients included implementation of an endocrine database, utilization of a multidisciplinary thyroid cancer tumor board, and coordination of regional patient access through the Geisinger System Program for Thyroid and Parathyroid Disorders. Result(s) We identified 930 endocrine surgical cases at our institution managed over the past 3 years. A total of 281 patients have been reviewed thus far. A total of 185 thyroid surgeries were performed on 173 patients. Final pathology was benign in 99 (53.5%) patients;77 (41.6%) were welldifferentiated thyroid carcinomas. The average elapsed days from fine needle aspiration biopsy to surgery was 54.8 (with those >100 days excluded). Average elapsed days from biopsy to surgery in patients with molecular testing was 61.5 days compared with 49.9 days for those without molecular testing. These 2 averages were significantly different from each other (P=.02) but not from the overall average. Conclusion(s) In this presentation, the effective management of a large population of thyroid patients is demonstrated through the utilization of several critical clinical applications. We propose a care delivery scheme for the evaluation and management of thyroid patients utilizing multiple clinical access points together with a multidisciplinary program for endocrine disease management.