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Elderly patients at increased risk for postoperative complications after thyroidectomy
Elderly patients are more likely to develop significant pulmonary, cardiac and infectious complications after thyroidectomy, according to data from a population-based cohort study.
Researchers used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to collect data for an experimental cohort of 7,915 thyroidectomy cases from 2005 to 2008. Eighty percent of the patients were women, and they ranged in age from 16 to 89 years. They were compared with 3,575 parathyroidectomy controls.
Follow-up was 30 days post-operation.
The researchers’ goal was to determine whether thyroid surgery is as safe in elderly patients as it is in younger populations.
Cases were organized by CPT codes for: thyroid lobectomy (40%); total thyroidectomy (44%); completion thyroidectomy (3.5%); thyroidectomy plus neck dissection (9.7%); substernal goiter cervical approach (2.6%); and substernal goiter thoracic approach (0.5%).
Partial lobectomy, thyroid cyst excision and isthmusectomy were included in the thyroid lobectomy group. The control group included a collection of codes under parathyroidectomy, parathyroidectomy re-exploration, and parathyroidectomy plus mediastinal exploration.
The primary predictor variable for complications was age. Researchers separated participants into three age categories: young (aged 16-64 years); elderly (aged 65-79 years); and super-elderly (aged 80 years or older). The secondary predictor variable was preoperative comorbidities.
Raymon H. Grogan, MD, a researcher with the endocrine surgery research program at the University of Chicago Medical Center, and colleagues concluded that elderly patients were twice as likely (OR=2.1; 95% CI, 1.4-3.3) to have a complication compared with the young age group, and the super-elderly were five times as likely (OR=4.9; 95% CI, 2.5-9.6) to have a complication compared with the young age group.
Complications included urinary tract infection, wound infection, systemic infection, cardiac complications and pulmonary complications.
The young age group had the lowest postoperative complication rate (1%). The elderly group had a 2.2% complication rate, and the super-elderly had the highest complication rate at 5%, the researchers wrote.
Grogan and colleagues said it is important for elderly patients undergoing thyroid surgery to have an experienced team of primary care physicians, surgeons, anesthesiologists and nurses.
“As the baby boomer generation ages, the US population is becoming increasingly older, and because of this, more research with a focus on elderly patients needs to be a study priority,” Grogan said in a press release.
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