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Sakowitz S, Bakhtiyar SS, Khoraminejad B, Ebrahimian S, Madrigal J, Benharash P, Wu J. Thyroid surgery outcomes in octogenarians: A national analysis. Surgery 2023:S0039-6060(23)00053-3. [PMID: 37055292 DOI: 10.1016/j.surg.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND The incidence of thyroid pathology increases with age. Yet octogenarians may face increased rates of complications after thyroid surgery. Using a nationally representative cohort, we evaluated the outcomes of thyroidectomy among octogenarians. METHODS All patients ≥55 years who underwent inpatient thyroidectomy were identified using the 2010 to 2020 National Readmissions Database. Patients ≥80 years were classified as octogenarians (others: nonoctogenarians). Multivariable models were built to evaluate independent associations between octogenarians and key clinical and financial outcomes. RESULTS Of 120,164 hospitalizations, 9,163 (7.6%) were octogenarians. The proportion of octogenarians undergoing thyroidectomy increased from 7.7% (2010) to 8.7% (2020) (nptrend <0.001). Octogenarians were more frequently female (72.1 vs 70.5%, P < .001), presented with a higher Elixhauser comorbidity index (3 [2-4] vs 2 [1-3], P < .001), and more commonly faced thyroid cancer (41.3 vs 32.7%, P < .001). After risk adjustment, octogenarians were associated with greater odds of experiencing any perioperative complication (adjusted odds ratio 1.36, 95% confidence interval 1.25-1.48). Octogenarians were further linked with greater odds of respiratory (adjusted odds ratio 1.82, 95% confidence interval 1.52-2.17) and renal complications (adjusted odds ratio 1.90, 95% confidence interval 1.45-2.49), dysphagia (adjusted odds ratio 1.51, 95% confidence interval 1.33-1.72), laryngeal edema (adjusted odds ratio 2.03, 95% confidence interval 1.30-3.18), vocal cord paralysis (adjusted odds ratio 1.79, 95% confidence interval 1.53-2.09), and stridor (adjusted odds ratio 1.42, 95% confidence interval 1.01-2.00). No difference in hypocalcemia was observed. Furthermore, octogenarians demonstrated an increased likelihood of in-hospital mortality (adjusted odds ratio 6.34, 95% confidence interval 3.11-12.53), hospitalization expenditures (+$910, 95% confidence interval +$420-1,400), and nonelective readmission within 30 days of discharge (adjusted odds ratio 1.54, 95% confidence interval 1.32-1.79). CONCLUSION Octogenarians are associated with greater morbidity after thyroidectomy. Patients ≥80 years should be counseled about increased perioperative risk when discussing surgical versus nonsurgical treatments for thyroid disease.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA. https://twitter.com/sarasakowitz
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO. https://twitter.com/Aortologist
| | - Baran Khoraminejad
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA
| | - Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA
| | - Josef Madrigal
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - James Wu
- Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA.
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Farhad SA, Anders B, Erik N, Martin N, Martin A. Mortality after benign thyroid surgery in patients aged 80 years or older. Langenbecks Arch Surg 2022; 407:1659-1665. [PMID: 35286467 PMCID: PMC9283352 DOI: 10.1007/s00423-022-02463-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
Introduction A recent report from the United Nations showed that aged people are increasing worldwide. Few data exist on overall survival for patients 80 years or older undergoing benign thyroid surgery. Short- and long-term survival and risk factors for death in patients undergoing thyroid surgery for benign disease were evaluated, using a nationwide, population-based quality register. Methods Patients operated for benign thyroid disease, 2004 to 2017, were collected from the national quality register for thyroid surgery. Mortality data were retrieved from the Swedish National Board of Health and Welfare. Mortality at 30 days, 90 days, and 1 year after surgery, for patients 80 years or older, was calculated. Overall survival was calculated using the Kaplan–Meier estimate. Risk factors for mortality were assessed with Cox’s multiple regression analysis. The standardized mortality ratio was calculated. Results There were 17,969 patients. Among them, 483 patients were 80 years or older, and of these, 397 (82.2%) were women. The mortality rate at 0–30 days, 31–90 days, and at 91–365 days after surgery was 0.4%, 0.2%, and 2.5%, respectively. The median (IQR) follow-up time was 4.5 (2.9–7.2) and the median (IQR) survival time was 8.0 (4.1–12.5) years. Apart from age, there was no other risk factor for death. The standardized mortality ratio (SMR) was 0.67 (0.49–0.91) for men and 0.76 (0.65–0.89) for women. Conclusion Mortality after surgery for benign thyroid disease in patients 80 years or older was lower than the general population with no specific risk factors for death except for age.
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Levi L, Reuven Y, Ben-Ner D, Koch N, Gunders-Peleg M, Nachalon Y, Koren I, Hazan A, Nakache G, Reifen E, Soudry E. Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk? Am J Rhinol Allergy 2021; 36:91-98. [PMID: 34236249 DOI: 10.1177/19458924211025374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. OBJECTIVE To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. METHODS Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. RESULTS We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. CONCLUSIONS Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.
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Affiliation(s)
- Lirit Levi
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Noam Koch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Koren
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alain Hazan
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | - Ella Reifen
- 36632Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Finnerty BM, Gray KD, Ullmann TM, Zarnegar R, Fahey TJ, Beninato T. Frailty is More Predictive than Age for Complications After Thyroidectomy for Multinodular Goiter. World J Surg 2021; 44:1876-1884. [PMID: 32052107 DOI: 10.1007/s00268-020-05422-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Risks of thyroidectomy for multinodular goiter (MNG) in older and frail patients are unclear, particularly regarding hematoma and recurrent laryngeal nerve (RLN) palsy. METHODS MNG patients undergoing total thyroidectomy were reviewed in the ACS-NSQIP procedure-targeted database (2016-2017). Outcomes were analyzed between adult (age <65), older-adult (age ≥65 and <80), and oldest-old (age ≥80) patients. Five-factor modified frailty index (mFI-5) was calculated based on functional status, diabetes, COPD, CHF, and hypertension, and used in comparative analyses. RESULTS A total of 2189 adult, 635 older-adult, and 59 oldest-old patients were included. Compared to adult patients, older-adult and oldest-old patients had higher mFI-5 ≥0.4 rates (14% vs. 22% vs. 31%, respectively, p < 0.001). The overall complication rate was 17.0% and similar between groups; however, oldest-old patients had higher rates of surgical site infection (3.4% vs. 0.3% vs. 0.4%), pneumonia (5.1% vs. 0.3% vs. 0.2%), and readmission (10.2% vs. 2.4% vs. 2.6%) compared to older-adult and adult patients, respectively (p < 0.05). On multivariable analyses of thyroidectomy-specific complications, mFI-5 ≥0.4 (OR 2.5, 95%-CI 1.4-4.4) and bleeding disorder (OR 4.6, 95%-CI 1.3-16.3) were predictive of hematoma, whereas vessel-sealant device usage (OR 0.4, 95%-CI 0.3-0.7) was protective. mFI-5 ≥ 0.4 (OR 1.5, 95%-CI 1.1-2.2), bleeding disorder (OR 2.8, 95%-CI 1.04-7.8), parathyroid autotransplantation (OR 1.7, 95%-CI 1.2-2.6), and prolonged operative time (OR 1.4, 95%-CI 1.02-1.8) were predictive of RLN palsy. Age was not a significant predictor of hematoma or RLN palsy. CONCLUSIONS Patients ≥80 years old are at increased risk for systemic complications and readmission after thyroidectomy for MNG. Frailty index better risk-stratifies patients than age for thyroidectomy-specific complications.
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Affiliation(s)
- Brendan M Finnerty
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA.
| | - Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA
| | - Timothy M Ullmann
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA
| | - Toni Beninato
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, F-838, New York, NY, 10065, USA
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