SUN-394 - National Thyroid Surgical Trends in Mexico'S Public Hospital System, 2008-2024

Few studies assess thyroid surgical practice patterns in Mexico.1,2,3,4 The American Thyroid Association (ATA, 2015) and the Mexican Society of Oncology’s clinical guidelines (SMEO, 2019) recommend de-escalating surgery for low-risk differentiated thyroid cancer. We determined whether surgical practice patterns evolved with changing international and national guidelines.5,6,7,8

Using Mexico’s national public hospital discharge database, we identified all encounters for total thyroidectomy (TT) or thyroid lobectomy (TL) from 2008 to 2024. Surgical cases and associated diagnoses were extracted via ICD-9 and -10 codes. We used segmented interrupted time series regression with interruption points at 2015 (ATA), 2019 ( SMEO), and 2020 (COVID-19 pandemic), and assessed for changes in level and slope of TL and TT rates per 100,000 population at each interruption point using national census data (2010, 2020). We accounted for autocorrelation using Newey-West standard errors. Analyses were performed in R (version 4.5.2) using R Studio (version 2025).

Between 2008-2024, a total of 30,457 thyroidectomies (including TT [n=12,306, 40%] and TL [n=18,060, 60%]) were performed across 544 total hospitals (median 162 unique hospitals/year (IQR 150-169)). Median age was 46 years (IQR 34-57), 3% were pediatric, and 88% were female. Most cases (n=24,635, 81%) were performed under general anesthesia, while 3,634 cases (12%) used regional anesthesia. Indications for surgery were malignant/unknown neoplasm (n=11,249, 37%) and benign (n=19,208, 63%) lesions. In 2024, hospitals in the highest volume quartile (>18 thyroidectomies/year) performed 78.4% of cases. After 2015, there was a slight increase in the rate of TL for malignant/unknown neoplasms (+0.12 cases/100,000 population/year [p < 0.001]), while TT rates for malignant/unknown neoplasms remained stable. In 2019, the rate of TT for malignant disease decreased by 0.14/100,000 population/year (p=0.01). From 2019-2020, all thyroid surgery rates declined from 2.58/100,000 to 1.13/100,000 population. After 2020, surgery rates rebounded to 3.17/100,000 in 2024, reflecting a pre-COVID trajectory.

Longitudinal practice patterns shifted towards lobectomy beginning in 2015, concurrent with international guidelines. The COVID-19 pandemic prevented assessment of sustained adherence. Post-pandemic data beyond 2024 is critical to determine whether guideline-concordant practices have been maintained.

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