A population-based study of outcomes from thyroidectomy in aging Americans: at what cost?

Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
Journal of the American College of Surgeons (Impact Factor: 4.45). 06/2008; 206(3):1097-105. DOI: 10.1016/j.jamcollsurg.2007.11.023
Source: PubMed

ABSTRACT We wanted to evaluate clinical and economic outcomes after thyroidectomy in patients 65 years of age and older, with special analyses of those aged 80 years and older, in the US.
This was a population-based study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2003-2004, a national administrative database of all patients undergoing thyroidectomy and their surgeon providers. Independent variables included patient demographic and clinical characteristics and surgeon descriptors, including case volume. Clinical and economic outcomes included mean total costs and length of stay (LOS), in-hospital mortality, discharge status, and complications.
There were 22,848 patients who underwent thyroidectomies, including 4,092 (18%) aged 65 to 79 years and 744 (3%) 80 years of age or older. On a population level, patient age is an independent predictor of clinical and economic outcomes. Average LOS for patients 80 years and older is 60% longer than for similar patients 65 to 79 years of age (2.9 versus 2.2 days; p < 0.001), complication rates are 34% higher (5.6% versus 2.1%; p < 0.001), and total costs are 28% greater ($7,084 versus $5,917; p < 0.001). High-volume surgeons have shorter LOS and fewer complications but perform fewer thyroidectomies for aging Americans; although they do nearly 29% of these procedures in patients younger than 65 years, they do just 15% of thyroidectomies in patients 80 years and older and 23% in patients 65 to 79 years.
On a population level, clinical and economic outcomes for patients 65 years and older undergoing thyroidectomies are considerably worse than for similar, younger patients. The majority of thyroidectomies in aging Americans is performed by low-volume surgeons. More data are needed about longterm outcomes, but increased referrals to high-volume surgeons for aging Americans are necessary.

  • Annals of Surgical Oncology 06/2014; · 3.94 Impact Factor
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    ABSTRACT: It was with great interest that we read the editorial by Dr. Julie Ann Sosa, “What’s Old is New Again,” which reviews our recent publication ‘Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons,’’ in the current issue of Annals of Surgical Oncology.1Dr. Sosa has been a pioneer in the field of endocrine surgery and has paved the way for studies examining the relationships between volume and outcomes such as ours.We agree with Dr. Sosa that the relationship between provider volume and improved patient outcomes is not a novel discovery and has been demonstrated for a number of operations. With regard to thyroid surgery, these relationships have been demonstrated in both pediatric and geriatric thyroid patients.2–6Our study confirms previous findings as Dr. Sosa suggests, and it is currently the largest study of its kind. The fact that it confirms previous findings suggests that such findings are reproducible, and this should not be felt ...
    Annals of Surgical Oncology 11/2014; 21(12). · 3.94 Impact Factor
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    ABSTRACT: Objective: The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. Material and Methods: One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. Results: The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. Conclusion: Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia. Key Words: Thyroidectomy, transient hypocalcemia, permanent hypoparathyroidism, risk factors
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