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Martínez-Montoro JI, Doulatram-Gamgaram VK, Olveira G, Valdés S, Fernández-García JC. Management of thyroid dysfunction and thyroid nodules in the ageing patient. Eur J Intern Med 2023; 116:16-26. [PMID: 37394383 DOI: 10.1016/j.ejim.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
Thyroid dysfunction is a common endocrine disorder in the general population, with a reported prevalence of 10-15%. However, this rate is even higher in older adults, with an estimated prevalence of ≈25% in some populations. Since elderly patients usually present more comorbidities than younger individuals, thyroid dysfunction may carry a synergistic negative health impact, mainly due to increased cardiovascular disease risk. Moreover, thyroid dysfunction in the elderly can be more difficult to diagnose due to its subtle or even asymptomatic clinical presentation, and the interpretation of thyroid function tests may be affected by drugs that interfere with thyroid function or by the coexistence of several diseases. On the other hand, thyroid nodules are also a prevalent condition in older adults, and its incidence increases with age. The assessment and management of thyroid nodules in the ageing patient should take into account several factors, as risk stratification, thyroid cancer biology, patient´s overall health, comorbidities, treatment preferences, and goals of care. In this review article, we summarize the current knowledge on the pathophysiology, diagnosis, and therapeutic management of thyroid dysfunction in elderly patients and we also review how to identify and manage thyroid nodules in this population.
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Affiliation(s)
- José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Viyey Kishore Doulatram-Gamgaram
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain
| | - Gabriel Olveira
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Sergio Valdés
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - José Carlos Fernández-García
- Department of Endocrinology and Nutrition, Regional University Hospital of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Plataforma Bionand, Malaga, Spain; Faculty of Medicine, Departamento de Medicina y Dermatología, University of Málaga, Málaga, Spain.
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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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Papoian V, Marji FP, Rosen JE, Carroll NM, Felger EA. Safety of Thyroid Surgery in the Elderly: A Propensity Score Matched Cohort Study. J Surg Res 2019; 242:239-243. [PMID: 31102915 DOI: 10.1016/j.jss.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/16/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Thyroid surgery is becoming more common in the elderly as elderly population continues to grow. We aim to evaluate the relative risk of morbidity from thyroidectomy in patients greater than 75 y of age. METHODS A retrospective analysis was performed for patients who were undergoing thyroidectomy between 2001 and 2018 in a multihospital network. A matched control group was selected with use of a propensity score, which was based on gender, ethnicity, type of surgery, insurance status, and comorbidities. The Charlson Comorbidity Index was used to quantify comorbidities. Total complications included both thyroid-specific and systemic complications. RESULTS We identified 313 patients over the age of 75 y with a propensity score matched group of 313 patients. There was no difference between the percent female (73% versus 73%, P = 0.92), race composition (P = 0.91), insurance status (P = 0.99), percent undergoing total thyroidectomy (84% versus 84%, P = 0.91), and Charlson Index (2.6 versus 2.69, P = 0.70) of the two groups. Overall complications (4.8% versus 1.9%, P = 0.05) and thrombotic events (1.2 versus 0%, P = 0.04) were significantly higher but there was no statistically significant difference between postoperative emergency room visits (7% versus 6%, P = 0.61), readmissions (11.5% versus 8.6%, P = 0.18), cardiovascular (1.3 versus 0.6%, P = 0.61), pulmonary (3.2 versus 0.9%, P = 0.07), or neurologic complications (1.0 versus 0.3%, P = 0.34). No reoperations were noted in either group. Elder patients did have a longer length of stay (2.64 versus 1.29 d, P < 0.01). CONCLUSIONS Elderly patients did have a longer length of stay when compared to a matched younger population. Although there was a trend with higher complication rates in the elderly, those differences did not reach statistical significance.
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Affiliation(s)
- Vardan Papoian
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia.
| | - Fadi P Marji
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Jennifer E Rosen
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Nancy M Carroll
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Erin A Felger
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
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Duskin-Bitan H, Leibner A, Amitai O, Diker-Cohen T, Hirsch D, Benbassat C, Shimon I, Robenshtok E. Bone-Marrow Suppression in Elderly Patients Following Empiric Radioiodine Therapy: Real-Life Data. Thyroid 2019; 29:683-691. [PMID: 31084551 DOI: 10.1089/thy.2018.0423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Elderly patients with differentiated thyroid cancer (DTC) tend to have more advanced disease at presentation, for which high activities of radioiodine (RAI) are often recommended. However, the 2015 American Thyroid Association guidelines recommend that empirically administered activities of RAI >150 mCi should be avoided in patients >70 years of age, based on calculated bone-marrow exposure according to two dosimetry-based studies. This study aimed to evaluate the effect of RAI treatment on bone-marrow function in elderly DTC patients. Methods: DTC patients ≥70 years of age who received RAI treatment and on whom a complete blood count was performed before and after treatment were included. Blood counts within one year before RAI and one year following treatment were compared in order to assess for marrow suppression. The impact of demographic, clinical, and laboratory variables on complete blood count were assessed. Results: One hundred fifty-three treatments in 122 patients met inclusion criteria, with a mean patient age of 76 ± 4.3 years, and 75% were women. High-risk features at presentation included T4 disease in 17%, lymph node metastases in 34%, and distant metastases in 14%. Mean RAI activity was 136.8 ± 48 mCi (82% ≥ 100 mCi, 66% ≥ 150 mCi). Of 153 RAI treatments analyzed, 114 (74%) were first treatments, 28 (18%) second treatments, seven (5%) third treatments, and four (3%) fourth treatments. At 0-3 months after RAI treatment, there was a statistically significant decrease in platelets (238 ± 66 vs. 216 ± 69 × 109/L, 10% decrease; p < 0.001), white blood cells (WBC; 6.9 ± 2 vs. 6.1 ± 1.9 × 109/L, 13% decrease; p < 0.001), and hemoglobin (Hb) in women (12.8 ± 1.1 vs. 12.4 ± 1.1 g/dL, 3% decrease; p = 0.01). Mean platelets, WBC, Hb in women, and lymphocytes remained decreased (but within the reference range) one year after treatment. Subgroup analysis demonstrated platelet suppression only with activities ≥100 mCi, and WBC and Hb suppression only with activities ≥150 mCi, with mean values within the reference ranges. There were no clinically significant cytopenia events during follow-up. Conclusions: Empiric RAI treatment in elderly patients causes mild bone-marrow suppression, with little clinical significance. Activities of 150-200 mCi can be safely used when indicated.
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Affiliation(s)
- Hadar Duskin-Bitan
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Anat Leibner
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Oren Amitai
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Talia Diker-Cohen
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dania Hirsch
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Carlos Benbassat
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- 3 Endocrine Institute, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Ilan Shimon
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Eyal Robenshtok
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study. Am J Surg 2019; 217:767-771. [DOI: 10.1016/j.amjsurg.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/07/2018] [Accepted: 07/12/2018] [Indexed: 11/22/2022]
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Wong EH, Smith M, Fish B, Jani P, Palme CE, Smith MC, Riffat F. Thyroidectomy in octogenarians is not associated with poorer postoperative outcomes. Head Neck 2019; 41:2500-2506. [DOI: 10.1002/hed.25712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eugene H. Wong
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Murray Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
| | - Brian Fish
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Piyush Jani
- Department of Otolaryngology; Addenbrooke's Hospital; Cambridge United Kingdom
| | - Carsten E. Palme
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Mark C. Smith
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
| | - Faruque Riffat
- Department of Otolaryngology; Westmead Hospital; Westmead New South Wales Australia
- Sydney Medical School; University of Sydney; Camperdown New South Wales Australia
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7
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Echanique KA, Govindan A, Mohamed OM, Sylvester M, Baredes S, Yu-Lan Ying M, Kalyoussef E. Age-Related Trends of Patients Undergoing Thyroidectomy: Analysis of US Inpatient Data from 2005 to 2013. Otolaryngol Head Neck Surg 2019; 160:457-464. [PMID: 30829140 DOI: 10.1177/0194599818825455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As the country ages, thyroidectomies can be expected to be performed more frequently among the elderly. In this study, we stratified patients by age to explore demographics and complications of patients undergoing thyroidectomy. STUDY DESIGN Retrospective study with a national database. SETTING Nationwide Inpatient Sample. SUBJECTS AND METHODS A total of 414,079 thyroidectomy cases from 2005 to 2013 were identified. Complications, outcomes, demographics, length of stay, and hospital charges were evaluated among patients and stratified by age into 4 cohorts: younger (<65 years), advanced age (65-74 years), elderly (75-84 years), and superelderly (≥85 years). RESULTS Of 414,079 thyroidectomy cases identified, patients aged <65 years accounted for 75.6% of cases, while those aged 65-74, 75-84, and ≥85 years accounted for 16.3%, 7.2%, and 0.9%, respectively ( P < .001). There was a significant difference in length of stay, total hospital charges, and mortality throughout the different age groups ( P < .001), all trending upward with advancing age. In the aging population, incidence of recurrent laryngeal nerve injury, transfusion of erythrocytes, and acute cardiac complications increased with increasing age ( P < .001), while hypoparathyroidism decreased with age ≥65 but ≤85 years ( P < .001). Patients aged ≥75 years had increased odds of mortality as compared with their younger counterparts ( P < .001). CONCLUSION This study utilized a national database to describe and elucidate trends in older populations undergoing thyroidectomy. Thyroid-related complications, including blood transfusion and recurrent laryngeal nerve injury, increased with increasing patient age. This information will help to guide pre- and postoperative care for aging patients undergoing thyroidectomy.
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Affiliation(s)
- Kristen A Echanique
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aparna Govindan
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Omar M Mohamed
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael Sylvester
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mary Yu-Lan Ying
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Evelyne Kalyoussef
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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8
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Joseph KR, Edirimanne S, Eslick GD. Thyroidectomy for thyroid cancer in the elderly: A meta-analysis. Eur J Surg Oncol 2018; 45:310-317. [PMID: 30642604 DOI: 10.1016/j.ejso.2018.07.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 05/29/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Kyle R Joseph
- The Whiteley-Martin Research Centre, Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Senarath Edirimanne
- The Whiteley-Martin Research Centre, Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia.
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9
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Intraoperative Factors Influencing Postoperative Outcomes in Older Patients Undergoing Abdominal Surgery—Narrative Review. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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10
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Pellino G, Marcellinaro R, Candilio G, De Fatico GS, Guadagno E, Campione S, Santangelo G, Reginelli A, Sciaudone G, Riegler G, Canonico S, Selvaggi F. The experience of a referral centre and literature overview of GIST and carcinoid tumours in inflammatory bowel diseases. Int J Surg 2016; 28 Suppl 1:S133-41. [DOI: 10.1016/j.ijsu.2015.12.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 04/28/2015] [Accepted: 05/15/2015] [Indexed: 02/06/2023]
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Santangelo G, Pellino G, De Falco N, Colella G, D'Amato S, Maglione MG, De Luca R, Canonico S, De Falco M. Prevalence, diagnosis and management of ectopic thyroid glands. Int J Surg 2015; 28 Suppl 1:S1-6. [PMID: 26708843 DOI: 10.1016/j.ijsu.2015.12.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 04/25/2015] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm. We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed. Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma. ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT.
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Affiliation(s)
- Giuseppe Santangelo
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Gianluca Pellino
- Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Nadia De Falco
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Giuseppe Colella
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Salvatore D'Amato
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - M Grazia Maglione
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Roberto De Luca
- Department of the Head and Neck Surgery, Second University of Naples, Naples, Italy.
| | - Silvestro Canonico
- Division of General and Geriatric Surgery, Second University of Naples, Italy.
| | - Massimo De Falco
- Fifth Division of General Surgery and Special Surgical Techniques, Second University of Naples, Naples, Italy; Division of General and Geriatric Surgery, Second University of Naples, Italy.
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12
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Pellino IM, Pellino G. Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons’ medical practice and on health service. Updates Surg 2015; 67:331-7. [DOI: 10.1007/s13304-015-0338-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/14/2015] [Indexed: 02/07/2023]
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13
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Bayhan Z, Zeren S, Ozbay I, Kahraman C, Yaylak F, Tiryaki C, Ekici M. Mean Platelet Volume as a Biomarker for Thyroid Carcinoma. Int Surg 2015; 101:50-53. [PMID: 26160507 DOI: 10.9738/intsurg-d-15-00123.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AbstractObjective: This study aimed to determine the relationship between MPV and thyroid malignancy by comparing patients who underwent surgery for benign or malignant thyroid diseases. BACKGROUND Mean platelet volume (MPV) is a useful early indicator of platelet activation. Platelets differ in terms of functional activity and size. Large platelets are relatively new, more reactive and produce more thrombogenic factors. Therefore, in conditions that involve increased platelet activation, an increase in the proportion of young platelets and MPV is expected. PATIENTS AND METHODS This study involved 146 patients who underwent total thyroidectomy because of benign (99 patients) or malignant (47 patients) diseases of the thyroid. Data on age, sex, MPV, white blood cell (WBC) count, hemoglobin level and platelet count were collected retrospectively. RESULTS MPV was significantly higher in patients with malignant thyroid diseases than in those with benign thyroid diseases. Age, sex, hemoglobin level, WBC count and platelet count did not significantly differ between the two groups. CONCLUSION MPV was significantly higher in patients with thyroid malignancies than in patients with benign thyroid diseases. We propose that MPV might be an important predictive factor for thyroid malignancies. Further prospective studies with a larger number of patients in high-volume endocrine surgery centers are required to confirm our findings.
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Affiliation(s)
- Zulfu Bayhan
- b Dumlupinar University, Faculty of Medicine, Kutahya, 43100, Turkey
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14
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Pellino G, Sciaudone G, Selvaggi F, Canonico S. Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action. Updates Surg 2015; 67:235-45. [PMID: 25921360 DOI: 10.1007/s13304-015-0298-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/13/2015] [Indexed: 12/12/2022]
Abstract
Surgical site events, including surgical site infections (SSI), represent a major problem in general surgery. SSI are responsible of nuisance for patients, and can lead to important complications and disability, often needing prolonged postoperative stay with specific treatment and recovery in Intensive Care Units. These justify the higher costs due to SSI. Despite the growing body of evidence concerning SSI in general surgery, literature dealing with SSI after colorectal surgery is scarce, reflecting in suboptimal perception of such a relevant issue by colorectal surgeons and health authorities in Italy, though colorectal surgery is associated with higher rates of SSI. The best strategy for reducing the impact of SSI on costs of care and patients quality of life would be the development of a preventive bundle, similar to that adopted in the US through the colorectal section of the National Surgery Quality Improvement Project of the American College of Surgeons (ACS-NSQIP). This policy has been showed to significantly reduce the rates of SSI. In this scenario, incisional negative pressure wound therapy (NPWT) is likely to play a pivotal role. We herein reviewed the literature to report on the current status of preventive NPWT on surgical wounds of patients undergoing colorectal procedures with primary wound closure, suggesting evidence-based measures to reduce the impact of SSI, and to contain the costs associated with conventional NPWT devices by means of newer available technologies. Some explicative real life cases are presented.
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Affiliation(s)
- Gianluca Pellino
- Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy,
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