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Thyroid surgery complications more common than previously believed
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Thyroid surgery-specific complications developed within 1 year of thyroid surgery in 12% of adults with differentiated or medullary thyroid cancer, and 6% developed general complications, according to published findings.
“From the provider perspective, referring physicians should be aware that select populations with thyroid cancer may be more vulnerable to post-operative complications,” Maria Papaleontiou, MD, assistant professor of metabolism, endocrinology and diabetes at Michigan Medicine, told Endocrine Today. “These include patients older than 65 years old, those with other coexisting medical conditions and those with more widespread disease.”
Papaleontiou and colleagues evaluated data from the Surveillance, Epidemiology and End Results-Medicare database on 27,912 patients who underwent surgery for differentiated or medullary thyroid cancer between 1998 and 2011 to determine the rates of general complications within the 30 days of surgery and thyroid surgery-specific complications within 1 year.
Most participants were women (70.5%) and white (79.7%), and 47.6% were older than 65 years. Papillary thyroid cancer was the most common cancer (84.8%), followed by localized disease (63.9%). More than half of participants had a Charlson/Deyo comorbidity score of at least 2 (67%). Postoperative complications developed in 6.5% of participants, and 12.3% developed thyroid surgery-specific complications.
Postoperative complications were significantly higher in participants older than 65 years (general, OR = 2.61; 95% CI, 2.31-2.95; thyroid surgery specific, OR = 3.12; 95% CI, 2.85-3.42), those with a Charlson/Deyo comorbidity score of 1 (general, OR = 2.4; 95% CI, 1.66-3.49; thyroid surgery specific, OR = 1.88; 95% CI, 1.53-2.31) or a score of at least 2 (general, OR = 7.05; 95% CI, 5.33-9.56; thyroid surgery specific, OR = 3.62; 95% CI, 3.11-4.25), and those with regional (general, OR = 1.18; 95% CI, 1.03-1.35; thyroid surgery specific, OR = 1.31; 95% CI, 1.19-1.45) or distant disease (general, OR = 2.83; 95% CI, 2.3-3.47; thyroid surgery specific, OR = 1.85; 95% CI, 1.54-2.21). Total thyroidectomy led to higher rates of thyroid surgery-specific complications compared with lobectomy (OR = 1.59; 95% CI, 1.41-1.8), and participants undergoing lymph node resection had higher thyroid surgery-specific complications compared with those who did not (OR = 1.43; 95% CI, 1.31-1.57).
“Although our study did not evaluate surgeon volume, prior work has illustrated the relationship between high surgical volume and lower complication rates,” study researcher Megan R. Haymart, MD, an Endocrine Today Editorial Board member, told Endocrine Today. “Therefore, for patients at higher risk of complications, referral to high-volume surgeons may be optimal. In addition, efforts to effectively train low-volume surgeons in order to adopt best-practice strategies, decrease practice variation, and implement prompt recognition and management of post-operative complications are needed. Finally, given the risks, in select patients such as those with low-risk thyroid cancer, less aggressive surgical approaches may be appropriate.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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