Objectives
To determine whether thyroid surgery in patients ≥80 is associated with higher complication rates.
Background
The incidence of thyroid nodules increases with age and little information is available regarding the risks of thyroid surgery in elderly patients.
Methods
Out of 3568 patients undergoing thyroid surgery between July 2001 and October 2007 at a single institution, the records of 90 consecutive patients ≥80 years were retrospectively reviewed and compared to a cohort of 242 randomly selected patients aged 18–79, who underwent thyroid surgery during the same time period, using SAS statistical software. Clinical variables included age group, sex, medical co-morbidities, pre-operative diagnosis, substernal component, previous surgery, final pathology, length of stay (LOS), postoperative complications and mortality.
Results
Preoperative indications for surgery included benign disease in 51.1% vs. 40.9%, suspected malignancy in 18.9% vs. 26% and suspected follicular neoplasms including indeterminate/microfollicular cytology in 30% vs. 33.1% in the octogenarian patient group (≥80 yrs old) vs. the younger patient cohort (p=NS). Octogenarians had a 21.1% rate of significant malignancy on final pathology vs. 28.1% in the younger cohort (p=NS). The overall complication rate in the octogenarian group was 23.3% vs. 9.1% in the younger cohort (p=.0006). Male sex and lung disease were independent risk factors for perioperative complications. Complications unique to octogenarians included heart failure, atrial fibrillation, pneumonia, tracheotomy, urosepsis, blood transfusion, wound infection and ischemic colitis. There was no mortality in either group.
Conclusions
Patients ≥80 years of age can undergo successful thyroid surgery but with significantly higher morbidity. Earlier surgical intervention may be advised in those who are at high risk for disease progression whereas follow-up strategies without surgery may be advised for others.
There is no difference in the degree of DGER and acid exposure during treatment between patients who failed to respond and those who achieved complete symptom resolution on PPI once daily. GERD symptoms in the PPI failure group are more commonly associated with acid reflux than with DGER.
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