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Boyi T, Williams LC, Kafle S, Roche AM, Judson BL. Association of Age and Frailty With 30-Day Outcomes Among Patients Undergoing Oral Cavity Cancer Surgery. Otolaryngol Head Neck Surg 2023; 169:1523-1532. [PMID: 37595108 DOI: 10.1002/ohn.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To evaluate the impact of age and frailty on 30-day outcomes following surgery for oral squamous cavity carcinoma (OSCC). STUDY DESIGN Retrospective cross-sectional analysis. SETTING American College of Surgeons' National Quality Improvement Program (NSQIP) database. METHODS Patients who underwent OSCC resection were queried via NSQIP (2015-2020). Cases were stratified by age (18-65, 65-75, and older than 75) as well as by modified frailty index scores (mFI 0, mFI 1, and mFI 2+) for comparative analyses. Univariate and multivariable analyses were conducted to examine demographics, perioperative outcomes, and 30-day postoperative adverse events. RESULTS A total of 3238 patients who underwent OSCC surgery were identified and categorized as nongeriatric ("NGA," age 18-65), younger geriatric ("YGA," age 65-75), and older geriatric ("OGA," age >75) adults. Compared to NGA, geriatric patients had higher the American Society of Anesthesiologists classification, higher modified frailty index scores, and more comorbidities such as hypertension, congestive heart failure, chronic obstructive disease, and diabetes (p < .001). YGAs and OGAs were also less likely to undergo neck dissection (p < .001), composite resection (p = .006), and free flap reconstruction compared to NGAs (p < .001). When controlling for confounders, age was not independently associated with an increased risk of poor outcomes. On the other hand, frailty was found to be independently associated with a higher risk of adverse events (odds ratio: 1.40 [1.15-1.70], p < .001 for mFI 1, odds ratio: 1.45 [1.04-2.02], p = .027 for mFI 2+). CONCLUSION A higher mFI score, not older age, is associated with an increased risk of 30-day complications following OSCC surgery.
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Affiliation(s)
- Trinithas Boyi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lauren C Williams
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Samipya Kafle
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ansley M Roche
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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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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Alyahya KA, Alarfaj AA, Alyahya AA, Alnaim AE. Indications and complications for surgical management of thyroid diseases: A single center experience. Ann Med Surg (Lond) 2022; 79:103980. [PMID: 35860099 PMCID: PMC9289332 DOI: 10.1016/j.amsu.2022.103980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Thyroid disorders are one of the most common endocrine disorders. Thyroid disorders are highly prevalent in the Saudi population. There are many approaches to treat thyroid disorders, varying from conservative to surgical, depending on the severity of each condition. There are many indications for surgical management of thyroid diseases, including carcinoma, hyperthyroidism, and local compression symptoms. Materials and methods This is a retrospective study included subjects operated upon for a thyroid disorder over 6 years period in the eastern province of Saudi Arabia. Results The clinical manifestations and postoperative characteristics of the patients are given in Table 2. It can be observed that the most dominant clinical presentation was neck mass (76.4%), while the most common indication of surgery was the suspicion of cancer (54.5%). Furthermore, the most common histopathology was papillary thyroid cancer (41.8%), whereas the most common complication after the surgery was hypocalcemia (9.1%). Likewise, total thyroidectomy was the most commonly sought surgical intervention (70.9%). Additionally, Bethesda class III constitutes 35.1%, while Bethesda class II constitutes 29.7%. Conclusion Suspicion of cancer was the most prominent indication for surgical intervention. The most prevalent postoperative complications were hypocalcemia. Furthermore, papillary thyroid carcinoma was the most common histological findings, which raises several questions since it contrasts with previous studies done in Saudi Arabia. We believe that the number of thyroid procedures in our region is underreported, and more research is needed to validate this. Most common indication for thyroid surgery was suspicion of malignancy. Most common post-operative histopathological finding was papillary thyroid cancer. Most common surgery done was total thyroidectomy. Majority of patient presented clinically with neck mass. Hypocalcemia was the most common post-operative complication observed. There's a lack of published research regarding the same topic.
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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: 0] [Impact Index Per Article: 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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Goshtasbi K, Birkenbeuel JL, Lehrich BM, Abiri A, Haidar YM, Tjoa T, Kuan EC. Association Between 5-Item Modified Frailty Index and Short-term Outcomes in Complex Head and Neck Surgery. Otolaryngol Head Neck Surg 2021; 166:482-489. [PMID: 33971756 DOI: 10.1177/01945998211010443] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs). STUDY DESIGN Cross-sectional database analysis. SETTING American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. RESULTS A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation (P = .021), longer length of stay (LOS) (P < .001), and higher rates of 30-day reoperation (P = .009), medical complications (P < .001), discharge to nonhome facility (DNHF) (P < .001), and mortality (P = .047). These parameters remained statistically significant when compared across all individual mFI scores (all P < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P < .05). CONCLUSION The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
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Saadi R, Brandt A, Kim Y, Cottrill E, Saunders B, Schaefer E, Goldenberg D. Degree of technical difficulty of thyroidectomy for autoimmune thyroid disease. Head Neck 2019; 42:262-268. [PMID: 31651072 DOI: 10.1002/hed.25991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/16/2019] [Accepted: 10/09/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Our goal was to elucidate the differences in degree of technical difficulty of thyroidectomy in patients with autoimmune thyroid diseases. METHODS Charts of adult patients who had undergone thyroidectomy were reviewed. Patients with Hashimoto's Thyroiditis (HT) or Graves' Disease (GD) were individually compared to a control group of patients with early stage malignancy or goiter. RESULTS The HT (n = 65) group was significantly more likely to have friable (P = .001) and fibrotic (P < .001) thyroids, longer operative times (P = .02), and a 22-modifier (P = .005). The GD (n = 169) group was significantly more likely to have friable (P < .001), vascular (P < .001), fibrotic (P = .038), and heavy (P = .002) thyroids, longer operative times (P = .03), increased length of stay (P = .01) and a 22-modifier (P = .01). CONCLUSION Our experience at an institution with a high-volume thyroid practice demonstrates that patients with autoimmune thyroid disease have consistent qualitative changes of the thyroid and significantly increased operative times and surgical difficulty.
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Affiliation(s)
- Robert Saadi
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Alyssa Brandt
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Yesul Kim
- Department of Dermatology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Elizabeth Cottrill
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Brian Saunders
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Eric Schaefer
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - David Goldenberg
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Seib CD, Rochefort H, Chomsky-Higgins K, Gosnell JE, Suh I, Shen WT, Duh QY, Finlayson E. Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations. JAMA Surg 2019; 153:160-168. [PMID: 29049457 DOI: 10.1001/jamasurg.2017.4007] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Frailty is a measure of decreased physiological reserve that is associated with morbidity and mortality in major elective and emergency general surgery operations, independent of chronological age. To date, the association of frailty with outcomes in ambulatory general surgery has not been established. Objective To determine the association between frailty and perioperative morbidity in patients undergoing ambulatory general surgery operations. Design, Setting, and Participants A retrospective cohort study was conducted of 140 828 patients older than 40 years of age from the 2007-2010 American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent ambulatory and 23-hour-stay hernia, breast, thyroid, or parathyroid surgery. Data analysis was performed from August 18, 2016, to June 21, 2017. Main Outcomes and Measures The association between the National Surgical Quality Improvement Program modified frailty index and perioperative morbidity was determined via multivariable logistic regression with random-effects modeling to control for clustering within Current Procedural Terminology codes. Results A total of 140 828 patients (80 147 women and 60 681 men; mean [SD] age, 59.3 [12.0] years) underwent ambulatory hernia (n = 71 455), breast (n = 51 267), thyroid, or parathyroid surgery (n = 18 106). Of these patients, 2457 (1.7%) experienced any type of perioperative complication and 971 (0.7%) experienced serious perioperative complications. An increasing modified frailty index was associated with a stepwise increase in the incidence of complications. In multivariable analysis adjusting for age, sex, race/ethnicity, anesthesia type, tobacco use, renal failure, corticosteroid use, and clustering by Current Procedural Terminology codes, an intermediate modified frailty index score (0.18-0.35, corresponding to 2-3 frailty traits) was associated with statistically significant odds ratios of 1.70 (95% CI, 1.54-1.88; P < .001) for any complication and 2.00 (95% CI, 1.72-2.34; P < .001) for serious complications. A high modified frailty index score (≥0.36, corresponding to ≥4 frailty traits) was associated with statistically significant odds ratios of 3.35 (95% CI, 2.52-4.46; P < .001) for any complication and 3.95 (95% CI, 2.65-5.87; P < .001) for serious complications. Anesthesia with local and monitored anesthesia care was the only modifiable covariate associated with decreased odds of serious 30-day complications, with an adjusted odds ratio of 0.66 (95% CI, 0.53-0.81; P < .001). Conclusions and Relevance Frailty is associated with increased perioperative morbidity in common ambulatory general surgery operations, independent of age, type of anesthesia, and other comorbidities. Surgeons should consider frailty rather than chronological age when counseling and selecting patients for elective ambulatory surgery.
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Affiliation(s)
- Carolyn D Seib
- Department of Surgery, University of California, San Francisco
| | - Holly Rochefort
- Department of Surgery, University of California, San Francisco
| | | | | | - Insoo Suh
- Department of Surgery, University of California, San Francisco
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco
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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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Sahli ZT, Zhou S, Najjar O, Onasanya O, Segev D, Massie A, Zeiger MA, Mathur A. Octogenarians have worse clinical outcomes after thyroidectomy. Am J Surg 2018; 216:1171-1176. [PMID: 29729944 DOI: 10.1016/j.amjsurg.2018.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The rising proportion of older adults in the US population coupled with an increased prevalence of nodular thyroid disease will result in more thyroidectomies being performed. The aim of this study is to evaluate the clinical outcomes among older adults (age ≥65) undergoing thyroidectomy compared to younger adults (18-64). METHODS This was a population-based study of adult thyroidectomy patients using the Premier Healthcare Database, 2005-2014. Discharge status, hospital length of stay (LOS), morbidity, and total patient charge were compared between younger adults and older adults in three different age groups: ≥65, ≥70, and ≥80 years old. RESULTS Among 75,141 thyroidectomy patients, 15,805 (21.0%) patients were ≥65 years, 8834 (11.8%) were ≥70 years, and 1613 (2.2%) were ≥80 years. Patients ≥80 years were 2.6 times (aOR:2.58, 95%CI: 1.72-3.86; p < 0.001) more likely to be discharged to a home health organization than to be discharged to their residence and 1.6 times (aOR:1.61, 95%CI: 1.30-2.00; p < 0.001) more likely to have at least one complication. CONCLUSIONS Age ≥80 is an independent predictor of worse clinical outcomes after thyroidectomy.
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Affiliation(s)
- Zeyad T Sahli
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sheng Zhou
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Omar Najjar
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Oluwadamilola Onasanya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dorry Segev
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Allan Massie
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Martha A Zeiger
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Aarti Mathur
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Sahli ZT, Ansari G, Gurakar M, Canner JK, Segev D, Zeiger MA, Mathur A. Thyroidectomy in older adults: an American College of Surgeons National Surgical Quality Improvement Program study of outcomes. J Surg Res 2018; 229:20-27. [PMID: 29936990 DOI: 10.1016/j.jss.2018.03.057] [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: 01/16/2018] [Revised: 03/05/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The growth of the US geriatric population coupled with the rise in thyroid nodular disease and cancer will result in an increased number of thyroidectomies performed in older adults. We aim to evaluate outcomes after thyroidectomy in older adults as compared with younger adults. METHODS A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2015 categorized thyroidectomy patients into three age groups: 18-64 y, 65-79 y, and ≥80 y. Thirty-day perioperative outcomes were analyzed using bivariate χ2 test and multivariate logistic regression to estimate risk of outcomes. RESULTS Our study identified 60,990 patients who underwent thyroidectomy: 47,855 (78.4%) patients between 18 and 64 y old, 11,716 (19.2%) between 65 and 79 y old, and 1419 (2.3%) ≥80 y. Compared with younger adults, patients aged ≥80 y were 2.67 times more likely to develop a complication (95% confidence interval [CI]: 2.02-3.53, P < 0.001), 1.83 times more likely to be readmitted for any reason (95% CI: 1.40-2.38, P < 0.001), 1.54 times more likely to be readmitted for a reason related to the thyroidectomy (95% CI: 1.10-2.16, P < 0.05), and 1.66 times more likely to have an extended hospital stay (95% CI: 1.44-1.91, P < 0.001). Patients aged 65-79 y were 1.40 times more likely to develop a complication (95% CI: 1.19-1.63, P < 0.001). CONCLUSIONS Patients aged ≥65 y have significantly higher rates of overall complications. In addition, patients aged ≥80 y have higher rates of total and thyroidectomy-related readmissions and extended length of hospital stay.
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Affiliation(s)
- Zeyad T Sahli
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ghedak Ansari
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Merve Gurakar
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Dorry Segev
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martha A Zeiger
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aarti Mathur
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Diagnostics of Thyroid Malignancy and Indications for Surgery in the Elderly and Younger Counterparts: Comparison of 3,749 Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1012451. [PMID: 29124061 PMCID: PMC5662825 DOI: 10.1155/2017/1012451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/11/2017] [Indexed: 01/14/2023]
Abstract
Background It seems valuable for clinicians to know if diagnostics of thyroid malignancy (TM) and indications for surgery in the elderly patients differ from these in younger counterparts. Materials and Methods Retrospective analysis of the medical records of 3,749 patients surgically treated for thyroid tumor. Data of patients with histopathology confirmed TM (n = 309) were studied. Results The rate of cytological prediction to malignancy was more than three times higher in elderly women. Compression was a main reason for surgery in the elderly (p < 0.0001). The final diagnosis of malignancy was significantly higher in older women (p = 0.002). Clinical suspicion of malignancy was positively correlated with histopathological diagnosis in total group of women (r = 0.543, p < 0.001) and total group of men (r = 0.560, p < 0.001). The subgroup of the eldest TM patients included a significantly higher number of subjects with advanced cancer and primary tumor progression (p < 0.0001). Distant metastases were significantly more presented among the elderly patients (p = 0.032). Conclusions The rate of cytological prediction to malignancy in elderly women is high. Tracheal compression is a common surgical indication in the elderly patients. The final diagnoses of malignancy predominate in elderly women. The oldest TM patients present a higher number of advanced thyroid tumors and distant metastases.
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Tabriz N, Uslar VN, Tabriz I, Weyhe D. Relationship between age and outcome in thyroid surgery: a prospective observational study. Innov Surg Sci 2017; 2:211-217. [PMID: 31579754 PMCID: PMC6754023 DOI: 10.1515/iss-2017-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022] Open
Abstract
Background: The occurrence of thyroid nodules and goiter increases with age. In general, surgery age is a predictor of perioperative morbidity. In thyroid surgery, there are different data on the role of age on morbidity. We investigated the influence of age on the outcome in thyroid surgery in a prospective single cohort study with a follow-up after 1 year. Methods: Total thyroidectomy or hemithyroidectomy was performed in euthyroid benign thyroid goiters (n=152). The primary endpoint was surgery duration. The secondary endpoints were weight of resected tissue, body mass index (BMI), amount and type of perioperative and long-term complications, and quality of life (QoL) preoperatively and 1 year postoperatively. Results: A significant three-way interactive relationship between age, surgery duration, and amount of resected tissue was found. An increase in any of these variables results in an increase in both other variables. The amount of perioperative complications was associated with resected tissue size. The QoL increases significantly after surgery by up to 10% and decreases significantly with age (mean QoL after surgery=84.9 of 100 for the youngest group and 75.7 of 100 for the oldest group). No long-term complications were recorded. Conclusion: The number of thyroid operations, especially of benign thyroid goiters, decreases annually in Germany. This can be explained by the fact that, on the one hand, the surgical indications are made more restrictive as conspicuous nodes are better clarified by improved technical aids. On the other hand, conservative measures (i.e. L-thyroxine and iodide administration) are used to achieve a size regimen of the goiter. Our results show that perioperative complications increase with patients’ age and surgery duration. However, the more restrictive surgical decision also entails the risk that patients will have to be operated at an older age and possibly with a bigger goiter, which is associated with higher operative morbidity. Therefore, in addition to the possibility of conservative therapy of the symptomatic goiter, the affected patients should also be thoroughly informed about the option to perform elective early thyroid surgery with regard to improved postoperative QoL and to keep the overall stress at a minimum for elderly patients.
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Affiliation(s)
- Navid Tabriz
- School of Medicine and Health Sciences, Medical Campus University of Oldenburg, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121 Oldenburg, Germany
| | - Verena Nicole Uslar
- School of Medicine and Health Sciences, Medical Campus University of Oldenburg, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Inga Tabriz
- School of Medicine and Health Sciences, Medical Campus University of Oldenburg, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Dirk Weyhe
- School of Medicine and Health Sciences, Medical Campus University of Oldenburg, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Oldenburg, Germany
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Papaleontiou M, Gauger PG, Haymart MR. REFERRAL OF OLDER THYROID CANCER PATIENTS TO A HIGH-VOLUME SURGEON: RESULTS OF A MULTIDISCIPLINARY PHYSICIAN SURVEY. Endocr Pract 2017; 23:808-815. [PMID: 28534681 DOI: 10.4158/ep171788.or] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Surgical outcomes of thyroid cancer patients are improved with high-volume surgeons. However, age disparities in referral to specialist surgical centers still exist. The factors that influence decision making regarding referral of older thyroid cancer patients to high-volume surgeons remain unknown. METHODS We surveyed members of the Endocrine Society, American College of Physicians, and American Academy of Family Practice. RESULTS Overall, 270 physicians completed the survey. Patient preference (69%), transportation barriers (62%), and confidence in local surgeon (54%) were the most cited factors decreasing likelihood of referral to a high-volume surgeon. In clinical scenarios, referral rates to a high-volume surgeon were similar for patients aged 40 and 65 years with a 1-cm thyroid nodule diagnostic of thyroid cancer (n = 137 [54%]; n = 132 [52%], respectively) as for an 85-year-old with a 4-cm nodule (n = 148 [59%]). When comorbidities were introduced, more physicians (n = 186 [74%]) would refer a 65-year-old with a 4-cm thyroid nodule and comorbidities, compared to an 85-year-old with the same nodule size without comorbidi-ties. In multivariable analysis, treating >10 thyroid cancer patients/year (P<.001; P<.005) and endocrinology specialty (P = .003; P = .003) were associated with referral to a high-volume surgeon for a 65-year-old with comorbidities and an 85-year-old without comorbidities, respectively. CONCLUSION Understanding surgical referral patterns of older thyroid cancer patients is vital in identifying obstacles in the referral process. We found that patient factors including comorbidities and physician factors including specialty and patient volume influence these patterns. This is the first step towards developing targeted interventions for these patients.
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Age-based disparities in the use of total thyroidectomy for papillary thyroid carcinoma. Clin Transl Oncol 2017; 19:1253-1259. [PMID: 28439795 DOI: 10.1007/s12094-017-1663-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Elderly patients may be less likely than younger patients to receive indicated therapy. We hypothesized that older patients with papillary thyroid carcinoma (PTC) would be less likely to receive total thyroidectomy (TT) than their younger counterparts. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database were queried for adult patients diagnosed with PTC from 2000 through 2009. Patients were categorized according to whether they received a TT or less than a total thyroidectomy (<TT). We used multivariate logistic regression to predict the use of <TT. The likelihood of undergoing <TT was reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS Of the 67,961 patients identified with PTC, 51,276 (75%) received TT, 14,750 (22%) <TT and 1935 (3%) no surgery. On multivariate analysis, advancing age increased the likelihood of receiving <TT (age 45-54 OR 1.15, CI [1.09-1.20]; age 55-64 OR 1.20, CI [1.14-1.26]; age 65-74 OR 1.40, CI [1.32-1.49]; 75-84 OR 1.80, CI [1.65-1.95]; ≥85 OR 3.01, CI [2.51-3.62], all p < 0.001). CONCLUSIONS Older patients with PTC are less likely to receive TT. Further research is needed to assess if older patients are negatively impacted by less complete surgery.
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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1268] [Impact Index Per Article: 158.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
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Abstract
INTRODUCTION The number of elderly people in Italy is growing, so it is important to study the presentation of diseases in these subjects. MATERIALS AND METHODS We selected 1362 patients who underwent thyroidectomy for different thyroid diseases from January 2008 to December 2014. The patients weredivided into two groups, according to the age. The patients aged 65 years and over were included in the group A, and the patients under the age of 65 years were included in the group B. DISCUSSION Thyroid diseases in the elderly often present with atypical symptoms which are very similar to symptoms of the aging process. In elderly hypothyroidism occurs frequently sub-clinically and hyperthyroidism is often presented with cardiovascular symptoms. In our study we evaluated the differences in incidence of thyroid diseases in the elderly and in the younger groups of patients. CONCLUSION The data analyzed in this study showed that in the elderly we have a reduced secretion and metabolization of thyroid hormones. The symptomatology in the elderly is nonspecific and can create a delay in the correct diagnosis.
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McLeod DSA, Carruthers K, Kevat DAS. Optimal Differentiated Thyroid Cancer Management in the Elderly. Drugs Aging 2015; 32:283-94. [DOI: 10.1007/s40266-015-0256-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Park HS, Jung CK, Lee SH, Chae BJ, Lim DJ, Park WC, Song BJ, Kim JS, Jung SS, Bae JS. Clinicopathologic Characteristics and Surgical Outcomes of Elderly Patients with Thyroid Cancer. Jpn J Clin Oncol 2014; 44:1045-51. [DOI: 10.1093/jjco/hyu132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Tartaglia F, Russo G, Sgueglia M, Blasi S, Tortorelli G, Tromba L, Krizzuk D, Merola R. Total thyroidectomy in geriatric patients: a retrospective study. Int J Surg 2014; 12 Suppl 2:S33-S36. [PMID: 25167851 DOI: 10.1016/j.ijsu.2014.08.386] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/19/2022]
Abstract
In the English literature there is no single definition that identifies elderly patients. In our retrospective study, we divided total thyroidectomized patients operated on from 2000 to 2010 in the Department of Surgical Sciences of the "Sapienza" University of Rome, in two groups: group 1 consists of 448 patients over 65 years and group 2 consists of 1275 patients under 65 years. We compared both groups in terms of indications for surgery, histological diagnoses, postoperative complications (laryngeal nerv palsy, hypocalcemia, bleeding and seroma) and mortality. The results showed no statistically significant differences between the two groups with respect to the type of surgical indication, the type of comorbidities, the incidence of postoperative complications and perioperative mortality. The only data discordant with those in the international literature was the incidence of neoplastic disease that is found to be slightly greater in group 2. In conclusion, total thyroidectomy in patients over 65 years is a safe procedure and is not burdened with a higher percentage of postoperative complications, even if requires a careful preoperative assessment of risk factors related to comorbidity.
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Affiliation(s)
- F Tartaglia
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - G Russo
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - M Sgueglia
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - S Blasi
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - G Tortorelli
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - L Tromba
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - D Krizzuk
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
| | - R Merola
- Department of Surgical Sciences - "Sapienza" University of Rome, Rome, Italy.
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Calò PG, Medas F, Loi G, Erdas E, Pisano G, Nicolosi A. Differentiated thyroid cancer in the elderly: our experience. Int J Surg 2014; 12 Suppl 2:S140-S143. [PMID: 25183640 DOI: 10.1016/j.ijsu.2014.08.362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 06/15/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to investigate clinical and pathologic characteristics of differentiated thyroid cancer in elderly patients and to evaluate the results of surgical treatment in this age group. METHODS The clinical records of patients who underwent total thyroidectomy between 2002 and 2012 with histopathological diagnosis of differentiated thyroid cancer were analyzed. Patients were divided into two groups: those 65 years old or older were included in group A (101), those younger in group B (354). RESULTS The mean surgical time was 100.9 ± 30.5 min in group A and 100.7 ± 27.6 in B. Postoperative stay was significantly longer in group A (2.8 ± 1.5 days vs 2.4 ± 0.7; p < 0.01). Classic papillary carcinoma was more frequent in group B, whereas follicular variant of papillary carcinoma and tall cell carcinoma in A. In group B node metastases were nearly twice. In Group A transient hypoparathyroidism occurred in 25 patients (24.8%), permanent hypoparathyroidism in 4 (4%), hematoma in 6 (5.9%), recurrent nerve palsy in 2 (2%), and wound infection in 2 (2%). In group B transient and permanent hypoparathyroidism occurred in 48 and 7 patients respectively (13.6% and 2%), hematoma in 4 (1.1%), recurrent nerve palsy in 5 (1.4%), and wound infection in 1 (0.3%). CONCLUSIONS Differentiated thyroid carcinoma is more aggressive in elderly patients for biological causes connected to age and to histotype but also for the diagnostic delay. Thyroid surgery in elderly patients is safe when the procedure is carried out by experienced staff. Total thyroidectomy is the surgical operation of choice.
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Affiliation(s)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giulia Loi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
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Korc-Grodzicki B, Downey RJ, Shahrokni A, Kingham TP, Patel SG, Audisio RA. Surgical considerations in older adults with cancer. J Clin Oncol 2014; 32:2647-53. [PMID: 25071124 DOI: 10.1200/jco.2014.55.0962] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. METHODS This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. RESULTS Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. CONCLUSION Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom.
| | - Robert J Downey
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Armin Shahrokni
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - T Peter Kingham
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Snehal G Patel
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
| | - Riccardo A Audisio
- Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom
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22
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Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre. Eur Arch Otorhinolaryngol 2014; 272:1503-8. [DOI: 10.1007/s00405-014-3068-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
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23
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Schwartz N, Shpitzer T, Feinmesser R, Robenshtok E, Bachar G. Thyroid surgery in the elderly. Gerontology 2013; 59:401-7. [PMID: 23988591 DOI: 10.1159/000351197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The increase in life expectancy combined with the relatively high incidence of thyroid disease requiring surgery in the elderly has raised questions concerning the appropriate management of the older patient. AIM Evaluation of the surgical management and outcome of thyroid disease requiring surgery in elderly patients. METHODS We performed a retrospective cohort study, in which the medical charts of 2,239 patients who underwent total thyroidectomy or hemithyroidectomy between 1995 and 2011 in a tertiary medical center were reviewed for clinical, disease-related, operative and outcome measures. Findings were analyzed between the patients aged more than 75 years for whom complete information was available (n = 255) and a control group of 100 patients aged 40-60 years matched for sex and extent of surgery. RESULTS The prevalence of comorbidities was significantly higher in the elderly. Presenting symptoms were similar in the two groups; in approximately 25% of both groups thyroid cancer was an incidental finding. There were no between-group differences in surgery duration, time to anesthesia induction, recovery time from anesthesia, or rate of postoperative complications. Hospitalization was 3 days longer on average in the older group. Malignancy rates and distribution of histologic subtypes were similar in the two groups, although the older group presented with significantly higher rates of advanced disease stage and larger tumors. There were no differences in recurrence rate both locoregional and distant metastases. However, a higher proportion of older patients failed to achieve cure. CONCLUSION Although older patients with thyroid disease have more comorbidities and advanced disease, there is no practical difference in their operative management and surgical outcome compared to younger patients. Surgery should not be deferred solely on the basis of age in the presence of compelling indications; rather, the decision should be based on individual risk-benefit analysis.
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Affiliation(s)
- N Schwartz
- Department of Otolaryngology - Head and Neck Surgery, Petach Tikva, Israel
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24
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Shuman AG, Patel SG, Shah JP, Korc-Grodzicki B. Optimizing perioperative management of geriatric patients with head and neck cancer. Head Neck 2013; 36:743-9. [PMID: 23596001 DOI: 10.1002/hed.23347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/01/2013] [Accepted: 04/05/2013] [Indexed: 12/27/2022] Open
Abstract
Given emerging demographic trends, many more elderly patients are being diagnosed with head and neck cancers. The surgical care paradigm for this cohort of patients must take into account specific challenges inherent to geriatric perioperative management. This article attempts to summarize the existing body of literature relevant to the geriatric head and neck cancer population, and to extrapolate relevant data from geriatric perioperative medicine in order to better understand and guide management decisions. The involvement of geriatricians and of patients' primary care providers may be invaluable in assisting in complex perioperative decision-making and in participating in longitudinal management. Preoperative risk stratification and assessment of medical, social, and functional variables are critical for appropriate decision-making in this challenging patient population.
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Affiliation(s)
- Andrew G Shuman
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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25
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Miccoli P, Fregoli L, Rago R, Matteucci V, Miccoli M, Materazzi G. Increased costs of perioperative risk assessment for thyroid surgery in elderly people (over 80 years) presenting with benign disease. Langenbecks Arch Surg 2013; 398:525-30. [PMID: 23553353 DOI: 10.1007/s00423-013-1075-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/26/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Evaluate how surgical treatment of benign thyroid disease in elderly people is prone to induce an increase of costs in the next future due to the aging process of the population. METHODS A retrospective analysis has been performed on a total of 116 patients operated between January 2007 and September 2011, divided in a group of 58 patients aged over 80 years (Group A) and 58 patients younger than 80 years (Group B). The analyzed data included age, preoperative diagnosis, severe co-morbidities, procedures other than standard needed to evaluate anaesthesiological risk, postoperative hospital stay, complications, duration of postoperative intensive care monitoring, pathologic characteristics, and costs of anaesthesiological risk assessment. RESULTS Statistical analysis of collected data showed that the costs related to perioperative risk assessment (p value < 0.001) and the duration of hospital stay (p value < 0.001) were higher in Group A than in Group B. Instead, surgery-related complications were not statistically different. CONCLUSIONS Despite feasibility and safety of modern surgical techniques, indications for surgery in elderly patients affected by benign thyroid disease should be reserved mainly for those patients with severe medical necessity.
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Affiliation(s)
- Paolo Miccoli
- Department of Pathology, University of Pisa, Pisa, Italy.
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Ng SH, Wong KP, Lang BHH. Thyroid surgery for elderly patients: are they at increased operative risks? J Thyroid Res 2012; 2012:946276. [PMID: 22970410 PMCID: PMC3431118 DOI: 10.1155/2012/946276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 06/20/2012] [Indexed: 11/18/2022] Open
Abstract
An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC), and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients.
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Affiliation(s)
- Sze-How Ng
- Breast and Endocrine Unit, Department of Surgery, Kuala Lumpur Hospital, 50586 Kuala Lumpur, Malaysia
| | - Kai-Pun Wong
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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Clinical and economic outcomes of thyroid surgery in elderly patients: a systematic review. J Thyroid Res 2012; 2012:615846. [PMID: 22779035 PMCID: PMC3388385 DOI: 10.1155/2012/615846] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 04/21/2012] [Indexed: 01/29/2023] Open
Abstract
The U.S. population is undergoing a dramatic shift in demographics, with a rise in the proportion of elderly Americans. Given an increased prevalence of thyroid disease and malignancy with age, understanding the safety of thyroid surgery in this age group is increasingly pertinent. There remains disagreement regarding the clinical outcomes of elderly patients after thyroidectomy and the applicability of single-institution cohorts to the population at large. This paper reviews the epidemiology of thyroid disease in the elderly, current surgical indications and practice patterns, and the clinical and economic outcomes of elderly patients with thyroid disease after surgical intervention.
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Results of General Surgical Treatment of Patients Over 80 Years of Age in Single-Site Experience. POLISH JOURNAL OF SURGERY 2012; 84:173-6. [DOI: 10.2478/v10035-012-0028-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Elderly patients constitute the largest group in oncologic medical practice, despite the fact that in solid cancers treated operatively, many patients are denied standard therapies and where such decision making is based solely on age. The “natural” assumptions that we have are often misleading; namely, that the elderly cannot tolerate complex or difficult procedures, chemotherapy, or radiation schedules; that their overall predictable medical health determines survival (and not the malignancy); or that older patients typically have less aggressive tumors. Clearly, patient selection and a comprehensive geriatric assessment is key where well-selected cases have the same cancer-specific survival as younger cohorts in a range of tumors as outlined including upper and lower gastrointestinal malignancy, head and neck cancer, and breast cancer. The assessment of patient fitness for surgery and adjuvant therapies is therefore critical to outcomes, where studies have clearly shown that fit older patients experience the same benefits and toxicities of chemotherapy as do younger patients and that when normalized for preexisting medical conditions,that older patients tolerate major operative procedures designed with curative oncological intent. At present, our problem is the lack of true evidence-based medicine specifically designed with age in mind, which effectively limits surgical decision making in disease-based strategies. This can only be achieved by the utilization of more standardized, comprehensive geriatric assessments to identify vulnerable older patients, aggressive pre-habilitation with amelioration of vulnerability causation, improvement of patient-centered longitudinal outcomes, and an improved surgical and medical understanding of relatively subtle decreases in organ functioning, social support mechanisms and impairments of health-related quality of life as a feature specifically of advanced age.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Aviv, Israel 52621.
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Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract 2011; 17:456-520. [PMID: 21700562 DOI: 10.4158/ep.17.3.456] [Citation(s) in RCA: 298] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011; 21:593-646. [PMID: 21510801 DOI: 10.1089/thy.2010.0417] [Citation(s) in RCA: 501] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition. METHODS The development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis. CONCLUSIONS One hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Rebecca S Bahn Chair
- Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic , Rochester, Minnesota 55905, USA.
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Medeiros-Neto G, Romaldini JH, Abalovich M. Highlights of the guidelines on the management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2011; 21:581-4. [PMID: 21663419 DOI: 10.1089/thy.2011.2106.ed2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Raffaelli M, Bellantone R, Princi P, De Crea C, Rossi ED, Fadda G, Lombardi CP. Surgical treatment of thyroid diseases in elderly patients. Am J Surg 2010; 200:467-72. [PMID: 20887839 DOI: 10.1016/j.amjsurg.2009.12.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 12/08/2009] [Accepted: 12/08/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND We evaluated the safety of thyroid surgery in elderly patients, in whom surgical procedures usually are considered more hazardous than in younger patients. METHODS The medical records of all the patients who were aged 70 years or older who had undergone thyroid surgery between January 1998 and June 2008 were reviewed. RESULTS A total of 320 patients were included. The preoperative diagnosis was multinodular goiter in 171 cases, toxic goiter in 59 cases, suspicious or indeterminate thyroid nodule in 60 cases, and thyroid carcinoma in 30 patients. Total thyroidectomy was performed in 283 patients, thyroid lobectomy in 15 patients, and a completion thyroidectomy was performed in 22 patients. The final histology showed thyroid cancer in 86 patients and benign disease in 234. CONCLUSIONS Thyroid surgery in patients aged 70 years or older is safe and the relatively high rate of thyroid carcinoma and toxic goiter may justify an aggressive approach.
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Affiliation(s)
- Marco Raffaelli
- Division of Endocrine Surgery-Department of Surgery, Università Cattolica del Sacro Cuore, L. go A. Gemelli 8, 00168 Rome, Italy.
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Tuggle CT, Park LS, Roman S, Udelsman R, Sosa JA. Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly. Ann Surg Oncol 2010; 17:2816-23. [PMID: 20552406 DOI: 10.1245/s10434-010-1144-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thyroid cancer increases in incidence and aggressiveness with age. The elderly are the fastest growing segment of the U.S. population. Reducing rates of rehospitalization would lower cost and improve quality of care. This is the first study to report population-level information characterizing rehospitalization after thyroidectomy among the elderly. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify patients older than aged 65 years with thyroid cancer who underwent thyroidectomy from 1997-2002. Patient and hospital characteristics were studied to predict the risk of rehospitalization. Outcomes were 30-day unplanned rehospitalization rate, cost, and length of stay (LOS) of readmission. RESULTS Of 2,127 patients identified, 69% were women, 84% had differentiated thyroid cancer, and 52% underwent total thyroidectomy. Mean age was 74 years. A total of 171 patients (8%) underwent 30-day unplanned rehospitalization. Rehospitalization was associated with increased comorbidity, advanced stage, number of lymph nodes examined, increased LOS of index admission, and small hospital size (all P < 0.05). Patients with a complication during index hospital stay were more likely to be readmitted (P < 0.001), whereas patients who saw an outpatient medical provider after index discharge returned less frequently (P < 0.001). Forty-seven percent of readmissions were for endocrine-related causes. Mean LOS and cost of rehospitalization were 3.5 days and $5,921, respectively. Unplanned rehospitalization was associated with death at 1 year compared with nonrehospitalized patients (18% vs. 6%; P < 0.001). DISCUSSION Rehospitalization among Medicare beneficiaries with thyroid cancer after thyroidectomy is prevalent and costly. Further study of predictors could identify high-risk patients for whom enhanced preoperative triage, improved discharge planning, and increased outpatient support might prove cost-effective.
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Affiliation(s)
- Charles T Tuggle
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Park HS, Roman SA, Sosa JA. Treatment patterns of aging Americans with differentiated thyroid cancer. Cancer 2010; 116:20-30. [PMID: 19908255 DOI: 10.1002/cncr.24717] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The incidence of differentiated thyroid cancer (DTC) increases with age. Total thyroidectomy, often followed by radioactive iodine (RAI), is recommended for patients who have tumors that measure > or =1 cm in greatest dimension. In the current study, the authors assessed the use of thyroidectomy and RAI among elderly patients with DTC and the effects on survival. METHODS Adults aged > or =45 years with DTC > or =1 cm in the Surveillance, Epidemiology, and End Results database from 1988 to 2003 were included. Bivariate and multivariate analyses were used to measure associations between demographic, clinical, and pathologic characteristics and the likelihood of receiving treatment according to current practice guidelines. RESULTS Of 8899 patients who were identified, 26% were ages 65 years to 79 years, and 5% were aged > or =80 years. Compared with younger patients, patients aged > or = 65 years were more likely to have larger tumors, stage IV disease, extrathyroid extension, and nonpapillary histology. Elderly patients were less likely to undergo total thyroidectomy (74% vs 80%; P < .001) or to receive RAI (47% vs 54%; P < .001). These trends were most pronounced among those aged > or =80 years. Among the patients who did not undergo surgery, elderly patients did not report higher rates of contraindications to surgery. In multivariate analysis, the groups ages 65 years to 79 years and aged > or =80 years were associated with lower rates of total thyroidectomy (odds ratio, 0.77 and 0.43, respectively; P < .001) and RAI (odds ratio, 0.85 [P < .01] and 0.39 [P < .001], respectively). Among elderly patients, predictors of worse survival included no surgery (hazard ratio, 5.51; P < .001) and no RAI (hazard ratio, 1.36; P < .001). CONCLUSIONS Elderly patients with DTC received less aggressive surgical and RAI treatment than younger patients despite having more advanced disease and the improved survival associated with these treatments among elderly patients. Long-term outcomes should be measured to determine the impact of this apparent discrepancy in care.
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Affiliation(s)
- Henry S Park
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA
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Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S. Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 2009; 146:913-21. [PMID: 19744461 DOI: 10.1016/j.surg.2009.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of thyroid nodules increases with age and little information is available regarding the risks of thyroid surgery in elderly patients. The aim of this study was to determine whether thyroid surgery in patients > or =80 is associated with higher complication rates. METHODS Out of 3,568 patients undergoing thyroid surgery between July 2001 and October 2007 at a single institution, the records of 90 consecutive patients > or =80 years were reviewed retrospectively and compared with a cohort of 242 randomly selected patients aged 18-79, who underwent thyroid surgery during the same time period. Clinical variables included age, gender, pre-operative diagnosis, substernal component, previous surgery, final pathology, length of stay, comorbidities, American Society of Anesthesiologists (ASA) score, body mass index, postoperative complications, and mortality. RESULTS Preoperative indications for surgery included benign disease in 51% vs 39%, suspected malignancy in 19% vs 26%, and suspected follicular neoplasms in 30% vs 35% in the octogenarian patient group (> or =80 years old) vs the younger patient cohort (P = NS). Octogenarians had 20% significant malignancy on final pathology vs 27% in the younger cohort (P = NS). The overall complication rate in the octogenarian group was 24% vs 9% in the younger cohort (P < .001). Male gender and ASA > or =3 were found to be independent risk factors for perioperative complications after thyroid surgery, while age alone was not. CONCLUSION Age > or =80 is associated with higher morbidity after thyroid surgery, although not independently. Earlier operative intervention may be advised in those at high risk for disease progression, whereas follow-up strategies without operation may be advised for others.
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Affiliation(s)
- Michal Mekel
- Department of Surgery and Endocrine Surgery Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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A Population-Based Study of Outcomes from Thyroidectomy in Aging Americans: At What Cost? J Am Coll Surg 2008; 206:1097-105. [DOI: 10.1016/j.jamcollsurg.2007.11.023] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 11/27/2007] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Although rare in non-endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge. METHODS From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome. RESULTS All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4-53 months), two patients died of cerebrovascular accident. CONCLUSION Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.
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Affiliation(s)
- Deepak Abraham
- Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China
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Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity Is a Prognostic Factor in Elderly Patients with Head and Neck Cancer. Ann Surg Oncol 2007; 14:1449-57. [PMID: 17235712 DOI: 10.1245/s10434-006-9296-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 11/02/2006] [Accepted: 11/09/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of aged patients with head and neck cancer is increasing. Comorbidities are common in this population. It is necessary to evaluate the effect of comorbidities as measured with the ACE-27 index on recurrence and survival of elderly patients with head and neck cancer, adjusting by other prognostic factors as age, clinical stage and functional status index. PATIENTS Three hundred and ten patients greater than 70 years of age with head and neck cancer in a referral cancer center were studied. Comorbidity measured with the ACE-27 index was the main independent variable. The outcomes were recurrence and survival. RESULTS Comorbidities were present in 75% of patients. Five-year disease-free survival, overall survival and cancer-specific survival were 63.1, 42.8 and 55.8%, respectively. Advanced clinical stage and Karnofsky index < or =70 were associated with recurrence. Age >80 years, male gender, Karnofsky index < or =80, advanced clinical stage, and ACE value > or =2 were independently associated with overall survival. The ACE-27 value was not associated with cancer-specific survival. The Karnofsky performance index was associated with overall survival and mortality and acted as a confounding factor on multivariable analysis on overall and cancer-specific survival. CONCLUSIONS Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer.
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Affiliation(s)
- Alvaro Sanabria
- Department of Head and Neck Surgery and Otorhinolaringology, Hospital do Câncer AC Camargo, Fundação Antonio Prudente, São Paulo, Brazil.
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Lang BHH, Lo CY. Total thyroidectomy for multinodular goiter in the elderly. Am J Surg 2005; 190:418-23. [PMID: 16105529 DOI: 10.1016/j.amjsurg.2005.03.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 03/07/2005] [Accepted: 03/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Total thyroidectomy for multinodular goiter (MNG) is increasingly being performed for the elderly population and yet their perioperative and long-term outcomes remain unclear. METHODS A total of 279 patients who underwent total thyroidectomy for MNG in a university-based hospital during a 9-year period were analyzed according to their age at the time of operation. RESULTS The duration of operation (P=.023), intraoperative blood loss (P=.030), weight of resected thyroid glands (P<.001) and proportion of retrosternal goiter (P<.001) were significantly greater in the elderly group (>/=70 years) (n = 55), but the incidence of surgically related complications, including recurrent laryngeal nerve palsy and hypoparathyroidism, was similar. Postoperative pneumonia occurred more frequently in the elderly group (P=.034). The number of comorbidities tended to correlate with the length of hospital stay and long-term survival in elderly patients. CONCLUSIONS Total thyroidectomy for MNG in elderly patients had a similar perioperative outcome as their younger counterparts, but their long-term outcome is likely to be influenced by the number of comorbidities.
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Affiliation(s)
- Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
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Ríos A, Rodríguez JM, Galindo PJ, Canteras M, Parrilla P. Surgical treatment for multinodular goitres in geriatric patients. Langenbecks Arch Surg 2005; 390:236-42. [PMID: 15654642 DOI: 10.1007/s00423-004-0521-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 09/09/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although age is not a contraindication for thyroid surgery, few elderly patients undergo surgery due to the greater risk of morbidity. The aims of this study are to determine in patients aged >65 years: (1) whether the indications for surgery on multinodular goitre (MG) differ with respect to younger patients; (2) the surgical results; and (3) whether the postsurgery morbidity and mortality rates are higher. PATIENTS AND METHOD Eighty-one patients aged over 65 years who were receiving surgery for MG were analysed; 40 49%) presented with associated co-morbidities. Sixty percent had thyroid symptoms, either compressive and/or toxic. All underwent programmed surgery following stabilisation and strict control of their co-morbidities. As a control group we used 510 MG patients receiving surgery and aged between 30 and 65 years. RESULTS Compared with the control group the geriatric patients had a longer time of goitre evolution (P=0.032), greater presence of symptoms (P=0.001) and a higher percentage of intrathoracic component (P=0.001). Compressive symptoms were the major indication for surgery (P=0.001). Postoperative complications occurred in 40% of the patients, a higher rate than in the control group (28%; P=0.011), although a large percentage of those complications were transitory. Definitive complications included two recurrent laryngeal nerve injuries (2.5%). The preoperative symptoms remitted in all the patients, and only three were associated with a thyroid carcinoma, one of which was anaplastic. CONCLUSIONS MG operated on in elderly patients has a longer evolution and an intrathoracic component, and surgery is indicated restrictively. With close monitoring of the co-morbidities and a programmed operation the results with regard to morbidity and mortality are similar to those obtained at younger ages.
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Affiliation(s)
- Antonio Ríos
- Department of General Surgery and Digestive Apparatus I, Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Ríos A, Manuel Rodríguez J, José Galindo P, Torregrosa NM, Canteras M, Parrilla P. Tratamiento quirúrgico del bocio multinodular en pacientes geriátricos. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
As the population ages and requires more health care, a significant part of this is in surgical services. As elderly patients account for a growing proportion of most surgeons' practices, it is apparent that this patient group has special requirements, differences in outcomes, and different physiology from other patients encountered in the typical surgical practice. The greater frequency of emergency operations in older than in younger patients, with higher morbidity and mortality rates, compounds these differences. This paper reviews the current status of general surgery in older patients with a special focus on emergency procedures, major abdominal surgery, biliary disease, endocrine disease, and breast cancer. Each of these areas is a source of considerable interest to general surgeons.
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Affiliation(s)
- Walter E Pofahl
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA.
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van Tol KM, de Vries EG, Dullaart RP, Links TP. Differentiated thyroid carcinoma in the elderly. Crit Rev Oncol Hematol 2001; 38:79-91. [PMID: 11255083 DOI: 10.1016/s1040-8428(00)00127-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The overall prognosis of patients with differentiated thyroid cancer is excellent, but the prognosis is rapidly worsening, when the disease is diagnosed in elderly patients. Old patients more often present with poor prognostic features, such as large tumors, follicular or Hürthle cell subtypes, extrathyroidal growth and distant metastases. Therefore, an optimal therapeutic approach is recommended. Current therapy includes a total thyroidectomy, if necessary combined with a lymph node dissection and followed by high dose radioiodine ablation. Radioiodine therapy in elderly patients meets specific problems, concerning thyroid hormone withdrawal, side effects of 131I and nursing problems. Additional treatment of residual, recurrent or metastatic disease must be tailored, according to the stage of the disease, and should not be denied on the basis of chronological age. Lifelong treatment with suppressive thyroid hormone therapy does not lead to important long-term side effects at old age.
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Affiliation(s)
- K M van Tol
- Department of Endocrinology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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