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Choosing thyroid procedure involves considerations for scarring, injury, cost
CHICAGO — When patients decide on the type of thyroidectomy procedure they will receive, they primarily weigh factors such as recurrent laryngeal nerve injury and mental nerve injury potential and cost, with younger patients also taking potential scarring into account, according to findings presented at the annual meeting of the American Thyroid Association.
“The effects of a visible neck scar after thyroid surgery for patients has likely been underestimated until more recently this decade, as newer surgical techniques have been developed that can enable thyroid surgery without a visible skin incision,” Insoo Suh, MD, FACS, an assistant professor of endocrine surgery at the University of California, San Francisco, told Endocrine Today. “We wanted to study how important the resulting scar would be for thyroid surgery patients compared to other factors. We used a method called a discrete choice experiment, which was originally developed in behavioral economics to help answer this question.”
As part of the discrete choice experiment that Suh described, the researchers recruited 109 adults to complete a questionnaire assessing five factors that may affect thyroidectomy technique choice: Recurrent laryngeal nerve injury likelihood, mental nerve injury likelihood, cost, where an incision was made and the distance to where the surgery was performed.
According to Suh, the factors that made the biggest difference were injury likelihood, cost and how far patients would have to travel to undergo the procedure (P < .001). The researchers also noted that the acceptable cost of lowering the likelihood of experiencing an injury to the recurrent laryngeal nerve by 1% was $3,842, and the acceptable cost of lowering the likelihood of experiencing an injury to the mental nerve by 1% was $1,060.
“One recently published study estimated that over half of patients undergoing thyroid — and parathyroid — operations today would meet indications for the ‘scarless’ technique,” Suh said. “The findings from our study allows us to identify better the patients in whom this technique would be preferred, have more informed discussions about the technique with them and study the value of this technique more broadly.”
The researchers also noted that procedures that featured a scarless approach were more likely to be selected by individuals younger than 60 years (P = .04), whereas the procedure with “a conventional neck incision” was chosen more frequently for individuals aged at least 60 years (P = .03).
“We found that age is an important determinant in whether one prefers a scarless or more conventional approach to thyroid surgery,” Suh said. “However, what was surprising was that our experimental model quantified what these patients were willing to trade off in other important factors in order to choose this approach over the conventional one. For example, younger patients were willing to choose the scarless approach even at the expense of significantly increased out-of-pocket cost, travel distance and even a small increase in complication rate.” – by Phil Neuffer
Reference:
Sukpanich R, et al. Poster 365. Presented at: 89th Annual Meeting of the American Thyroid Association; Oct. 30-Nov. 3, 2019; Chicago.
Disclosure: Suh reports he has consulted for Medtronic and Prescient Surgical.