Increased costs of perioperative risk assessment for thyroid surgery in elderly people (over 80 years) presenting with benign disease

Consumption of health resources in older people with differentiated thyroid carcinoma: a multicenter analysis

OBJECTIVE

There is hardly any information on the consumption of healthcare resources by older people with differentiated thyroid cancer (DTC). We analyzed these consumptions in older patients with DTC and compared patients 75 years and older with subjects aged 60-74 years.

METHODS

A multicenter, retrospective analysis was designed. We recorded three groups of health resources consumption (visits, diagnostic procedures, and therapeutic procedures) and identified a subgroup of patients with high consumption of resources. We compared patients aged between 60-74 years (group 1) with patients aged 75 and over (group 2).

RESULTS

We included 1654 patients (women, 74.4%), of whom 1388 (83.9%) belonged to group 1 and 266 (16.1%) to group 2. In group 2, we found a higher proportion of patients requiring emergency department visits (7.9 vs. 4.3%, P = 0.019) and imaging studies (24.1 vs. 17.3%; P = 0.012) compared to group 1. However, we did not find any significant difference between both groups in the consumption of other visits, diagnostic procedures, or therapeutic procedures. Overall, 340 patients (20.6%) were identified as high consumers of health resources, 270 (19.5%) in group 1 and 70 (26.3%) in group 2 (P = 0.013). Multivariate logistic regression analysis showed that the risk of recurrence and mortality, radioiodine treatment, tumor size, and vascular invasion were significantly related to the high global consumption of resources. However, the age was not significantly related to it.

CONCLUSION

In patients with DTC over 60 years of age, advanced age is not an independent determining factor in the consumption of health resources.

Thyroidectomy for thyroid cancer in the elderly: A meta-analysis

Thyroid cancer, the most common endocrine malignancy, has patients who generally have excellent prognosis. It has been shown that elderly patients are more likely to undergo sub-therapeutic management, despite having more aggressive disease, resulting in increased mortality and morbidity. The present study aimed to quantitatively investigate the risks of elderly patients who underwent thyroidectomy for thyroid cancer regarding mortality/survival, recurrence of disease, and complications arising from thyroidectomy. A systematic search and meta-analysis was carried out using the electronic databases PubMed and Medline. We searched for articles containing epidemiological evidence of mortality and recurrence of disease in patients above the age of 60, who are treated for operatively thyroid cancer and data involving complications following total thyroidectomy. The meta-analysis consisted of a total of 16 studies meeting the inclusion and exclusion criteria. The current study confirmed that patients have increased risk of recurrence (HR 4.84; 95% CI = 22.2-10.52; I² = 0.00; P = 0.98) including increased risk of lymph node recurrence and distant metastases. Additionally these patients had an increased risk of complications (OR 1.82; 95% CI = 0.88-3.77; I² = 77.01; P = 0.005) following thyroidectomy compared to patients in the younger cohort. The current study also qualitatively compared survival data between the different age cohorts, and identified a reduced overall survival and disease free survival for elderly patients. The current study suggests that elderly patients should be classified as higher risk following total thyroidectomy for thyroid cancer and puts an emphasis is early detection and intervention.

Outpatient thyroidectomy is safe in the elderly and super-elderly

OBJECTIVES

1) Determine the safety of outpatient thyroidectomy in the geriatric patient population. 2) Analyze the risk of postoperative complications from thyroid surgery in patients aged over 65 years (elderly) and aged over 80 years (super-elderly) undergoing ambulatory thyroidectomy compared to patients aged 21 through 40 years.

STUDY DESIGN

A retrospective analysis of consecutive patients undergoing thyroidectomy between January 2008 and July 2015 at a tertiary academic institution.

METHOD

Patients were stratified by age, and three subsets within this population were considered and analyzed further: youthful/control (aged 21-40 years), elderly (aged 65-79 years), and super-elderly (≥ 80 years). Patient demographics, surgical and pathological data, admission status, complication, and readmission rates were recorded.

RESULTS

A total of 1,429 thyroidectomies were accomplished; of these, 1,207 (84.5%) were outpatient operations. Among the outpatients, 85.2% were female, 14.1% were male, and the mean age was 50.3 ± 15.2 years. The control (youthful) group was comprised of 328 patients with a mean age of 33.3 years; the elderly group of 201 patients had a mean age of 70.3 years; and 16 patients in the super-elderly group had a mean age 82.7 years. The complication rates (5.2%, 5.0%, and 6.3%, respectively; P = 0.98) and re-admission rates (1.5%, 1.5%, and 0.0%, respectively; P = 0.89) were not different among these groups.

CONCLUSION

Outpatient thyroid surgery is as safe in appropriately selected elderly and super-elderly patients as it is in a control group of youthful patients. Therefore, age should not be a contraindication to conducting thyroidectomy on an ambulatory basis.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:290-294, 2018.