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Papoian V, Marji FP, Rosen JE, Carroll NM, Felger EA. Safety of Thyroid Surgery in the Elderly: A Propensity Score Matched Cohort Study. J Surg Res 2019; 242:239-243. [PMID: 31102915 DOI: 10.1016/j.jss.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/16/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Thyroid surgery is becoming more common in the elderly as elderly population continues to grow. We aim to evaluate the relative risk of morbidity from thyroidectomy in patients greater than 75 y of age. METHODS A retrospective analysis was performed for patients who were undergoing thyroidectomy between 2001 and 2018 in a multihospital network. A matched control group was selected with use of a propensity score, which was based on gender, ethnicity, type of surgery, insurance status, and comorbidities. The Charlson Comorbidity Index was used to quantify comorbidities. Total complications included both thyroid-specific and systemic complications. RESULTS We identified 313 patients over the age of 75 y with a propensity score matched group of 313 patients. There was no difference between the percent female (73% versus 73%, P = 0.92), race composition (P = 0.91), insurance status (P = 0.99), percent undergoing total thyroidectomy (84% versus 84%, P = 0.91), and Charlson Index (2.6 versus 2.69, P = 0.70) of the two groups. Overall complications (4.8% versus 1.9%, P = 0.05) and thrombotic events (1.2 versus 0%, P = 0.04) were significantly higher but there was no statistically significant difference between postoperative emergency room visits (7% versus 6%, P = 0.61), readmissions (11.5% versus 8.6%, P = 0.18), cardiovascular (1.3 versus 0.6%, P = 0.61), pulmonary (3.2 versus 0.9%, P = 0.07), or neurologic complications (1.0 versus 0.3%, P = 0.34). No reoperations were noted in either group. Elder patients did have a longer length of stay (2.64 versus 1.29 d, P < 0.01). CONCLUSIONS Elderly patients did have a longer length of stay when compared to a matched younger population. Although there was a trend with higher complication rates in the elderly, those differences did not reach statistical significance.
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Affiliation(s)
- Vardan Papoian
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia.
| | - Fadi P Marji
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Jennifer E Rosen
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Nancy M Carroll
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
| | - Erin A Felger
- Department of Surgery, MedStar Georgetown University/Washington Hospital Center, Washington, District of Columbia
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Duskin-Bitan H, Leibner A, Amitai O, Diker-Cohen T, Hirsch D, Benbassat C, Shimon I, Robenshtok E. Bone-Marrow Suppression in Elderly Patients Following Empiric Radioiodine Therapy: Real-Life Data. Thyroid 2019; 29:683-691. [PMID: 31084551 DOI: 10.1089/thy.2018.0423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Elderly patients with differentiated thyroid cancer (DTC) tend to have more advanced disease at presentation, for which high activities of radioiodine (RAI) are often recommended. However, the 2015 American Thyroid Association guidelines recommend that empirically administered activities of RAI >150 mCi should be avoided in patients >70 years of age, based on calculated bone-marrow exposure according to two dosimetry-based studies. This study aimed to evaluate the effect of RAI treatment on bone-marrow function in elderly DTC patients. Methods: DTC patients ≥70 years of age who received RAI treatment and on whom a complete blood count was performed before and after treatment were included. Blood counts within one year before RAI and one year following treatment were compared in order to assess for marrow suppression. The impact of demographic, clinical, and laboratory variables on complete blood count were assessed. Results: One hundred fifty-three treatments in 122 patients met inclusion criteria, with a mean patient age of 76 ± 4.3 years, and 75% were women. High-risk features at presentation included T4 disease in 17%, lymph node metastases in 34%, and distant metastases in 14%. Mean RAI activity was 136.8 ± 48 mCi (82% ≥ 100 mCi, 66% ≥ 150 mCi). Of 153 RAI treatments analyzed, 114 (74%) were first treatments, 28 (18%) second treatments, seven (5%) third treatments, and four (3%) fourth treatments. At 0-3 months after RAI treatment, there was a statistically significant decrease in platelets (238 ± 66 vs. 216 ± 69 × 109/L, 10% decrease; p < 0.001), white blood cells (WBC; 6.9 ± 2 vs. 6.1 ± 1.9 × 109/L, 13% decrease; p < 0.001), and hemoglobin (Hb) in women (12.8 ± 1.1 vs. 12.4 ± 1.1 g/dL, 3% decrease; p = 0.01). Mean platelets, WBC, Hb in women, and lymphocytes remained decreased (but within the reference range) one year after treatment. Subgroup analysis demonstrated platelet suppression only with activities ≥100 mCi, and WBC and Hb suppression only with activities ≥150 mCi, with mean values within the reference ranges. There were no clinically significant cytopenia events during follow-up. Conclusions: Empiric RAI treatment in elderly patients causes mild bone-marrow suppression, with little clinical significance. Activities of 150-200 mCi can be safely used when indicated.
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Affiliation(s)
- Hadar Duskin-Bitan
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Anat Leibner
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Oren Amitai
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Talia Diker-Cohen
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dania Hirsch
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Carlos Benbassat
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
- 3 Endocrine Institute, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Ilan Shimon
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Eyal Robenshtok
- 1 Endocrinology Institute, Rabin Medical Center, Petah-Tikva, Israel
- 2 Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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Echanique KA, Govindan A, Mohamed OM, Sylvester M, Baredes S, Yu-Lan Ying M, Kalyoussef E. Age-Related Trends of Patients Undergoing Thyroidectomy: Analysis of US Inpatient Data from 2005 to 2013. Otolaryngol Head Neck Surg 2019; 160:457-464. [PMID: 30829140 DOI: 10.1177/0194599818825455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As the country ages, thyroidectomies can be expected to be performed more frequently among the elderly. In this study, we stratified patients by age to explore demographics and complications of patients undergoing thyroidectomy. STUDY DESIGN Retrospective study with a national database. SETTING Nationwide Inpatient Sample. SUBJECTS AND METHODS A total of 414,079 thyroidectomy cases from 2005 to 2013 were identified. Complications, outcomes, demographics, length of stay, and hospital charges were evaluated among patients and stratified by age into 4 cohorts: younger (<65 years), advanced age (65-74 years), elderly (75-84 years), and superelderly (≥85 years). RESULTS Of 414,079 thyroidectomy cases identified, patients aged <65 years accounted for 75.6% of cases, while those aged 65-74, 75-84, and ≥85 years accounted for 16.3%, 7.2%, and 0.9%, respectively ( P < .001). There was a significant difference in length of stay, total hospital charges, and mortality throughout the different age groups ( P < .001), all trending upward with advancing age. In the aging population, incidence of recurrent laryngeal nerve injury, transfusion of erythrocytes, and acute cardiac complications increased with increasing age ( P < .001), while hypoparathyroidism decreased with age ≥65 but ≤85 years ( P < .001). Patients aged ≥75 years had increased odds of mortality as compared with their younger counterparts ( P < .001). CONCLUSION This study utilized a national database to describe and elucidate trends in older populations undergoing thyroidectomy. Thyroid-related complications, including blood transfusion and recurrent laryngeal nerve injury, increased with increasing patient age. This information will help to guide pre- and postoperative care for aging patients undergoing thyroidectomy.
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Affiliation(s)
- Kristen A Echanique
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aparna Govindan
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Omar M Mohamed
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael Sylvester
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mary Yu-Lan Ying
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Evelyne Kalyoussef
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Inversini D, Morlacchi A, Melita G, Del Ferraro S, Boeri C, Portinari M, Cancellieri A, Frattini F, Rizzo AG, Dionigi G. Thyroidectomy in elderly patients aged ≥70 years. Gland Surg 2017; 6:587-590. [PMID: 29142852 DOI: 10.21037/gs.2017.10.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Worldwide, the indications for thyroid surgery have been continuously extended among elderly patients in the last 20 years. The balance between treatment indication and surgical risk is certainly an interesting topic for every thyroid surgeon. This paper is a review of recent literature from January 2005 up to April 2017. We analyzed three principal subjects: indications for surgical treatment, medical complications and surgical complications. We can summarize the conclusions of our analysis, stating that age could not be considered as an absolute factor, but in relation to the comorbidities and the general clinical condition of the patient. Special risk indices dedicated to geriatric patients could be very useful in order to facilitate the decision-making process; however, relying on the current knowledge, we could state that there is value in providing surgery to geriatric patients in highly specialized and high-volume centers, where access to technology and its systematic use, coupled with surgeons' experience, could certainly avail the geriatric patient management.
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Affiliation(s)
- Davide Inversini
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Andrea Morlacchi
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Giuseppinella Melita
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Simona Del Ferraro
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Carlo Boeri
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Mattia Portinari
- Department of Surgery, S. Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Antonino Cancellieri
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Francesco Frattini
- ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, Varese 21100, Italy
| | - Antonio Giacomo Rizzo
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy
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Sagiv D, Migirov L, Lipschitz N, Dagan E, Glikson E, Wolf M, Alon EE. The admission patterns of octogenerians nonagenerians and centenarians to the Department of Otoloaryngology. Eur Arch Otorhinolaryngol 2016; 273:4615-4621. [PMID: 27356556 DOI: 10.1007/s00405-016-4165-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
Life expectancy in Israel has risen by almost 6 years during the last 25 years, and the proportion of people 65 years of age or older is expected to reach 12 % of the total population by 2020. A substantial increase in the workload for Otolaryngologists and Head and Neck surgeons is anticipated. Our goal was to characterize the admissions of patients 80 years of age and older to the Department of Otolaryngology, Head and Neck Surgery in a tertiary medical center. The study group included all patients 80 years of age and older who were admitted to the Department of OTOHNS in our institute between 2009 and 2013. There were two control groups for comparison divided by age; one group 40-59 years old and the other group 60-79 years old. There were 385 admissions of 317 patients aged 80-103 years (4.2 % of overall admissions). Over the study period, admissions of patients over 80 years increased on average by 3 % per annum (p = 0.4), and those patients over 90 years old by 52 % per annum (p < 0.001). The most common indication was HN malignancy (28.8 %) followed by otologic disorders (22.0 %). Of the overall 158 operations conducted, 131 patients (82.9 %) underwent elective procedures (mainly oncology) and 27 patients (17.1 %) underwent emergent procedures. The distribution of the reasons for admission of the patients older than 80 years is surprisingly different from that of the "younger" patients. With life expectancy rising, our study predicts a workload increase mainly in the HN oncologic and otologic services.
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Affiliation(s)
- Doron Sagiv
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
| | - Lela Migirov
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Lipschitz
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Elad Dagan
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Eran Glikson
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Michael Wolf
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran E Alon
- Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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