Article

A Population-Based Study of Outcomes from Thyroidectomy in Aging Americans: At What Cost?

Department of Surgery, Yale University, New Haven, Connecticut, United States
Journal of the American College of Surgeons (Impact Factor: 5.12). 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.

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    • "Specific complications after thyroidectomy are as the following: recurrent laryngeal nerve damage and post-surgical wound infection [8, 46]. These complications are inversely correlated with the experience of the surgeon and the annual number of such procedures [48]. The advantage of thyroidectomy is above all the fast relief of hyperthyrodism , while the disadvantages are as the following: general anesthesia, complication among 1–2% of patients such as recurrent laryngeal nerve palsy, hypoparathyroidism [46]. "
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    • "undergo total thyroidectomy than younger patients as overall patients had more preoperative comorbidities as reflected by a higher ASA class [4, 6]. In addition, the older thyroidectomy patients appear to have more advanced benign disease as substernal thyroidectomies were required for elderly and superelderly patients as compared to younger group [6]. Thyroid cancers behave generally more aggressive with increasing age [18, 25]. Park et al. evaluated 8899 patients who undergoing thyroidectomy and radioactive iodine (RAI) from the Surveillance, Epidemiology, and End Results (SEER) database in United States and found that older patients aged ≥65 years were more likely to have multiple primary tumours, advanced-staged disease, larger tumour, extrathyroidal extension, and nonpapillary histology [26]. "
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    • "Although the inverse association between hypocalcaemia and advancing age corroborates the work of others [27, 28], there is some conflict found in the literature. A previous study that also assessed the NIS, though for a narrower time frame, from 2003-2004, showed that patients 65 years and older, after adjusting for other risk factors, experienced similar rates of hypocalcemia and recurrent laryngeal nerve injury compared with younger patients [29]. In fact, older patients in the study had higher rates of total complications, consistent with a recent series [30]. "
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