Frailty is More Predictive than Age for Complications After Thyroidectomy for Multinodular Goiter

Abstract

Background Risks of thyroidectomy for multinodular goiter (MNG) in older and frail patients are unclear, particularly regarding hematoma and recurrent laryngeal nerve (RLN) palsy. Methods MNG patients undergoing total thyroidectomy were reviewed in the ACS-NSQIP procedure-targeted database (2016)(2017). Outcomes were analyzed between adult (age\65), older-adult (age C65 and\80), and oldestold (age C80) patients. Five-factor modified frailty index (mFI-5) was calculated based on functional status, diabetes, COPD, CHF, and hypertension, and used in comparative analyses. Results A total of 2189 adult, 635 older-adult, and 59 oldest-old patients were included. Compared to adult patients, older-adult and oldest-old patients had higher mFI-5 C0.4 rates (14% vs. 22% vs. 31%, respectively, p \ 0.001). The overall complication rate was 17.0% and similar between groups; however, oldest-old patients had higher rates of surgical site infection (3.4% vs. 0.3% vs. 0.4%), pneumonia (5.1% vs. 0.3% vs. 0.2%), and readmission (10.2% vs. 2.4% vs. 2.6%) compared to older-adult and adult patients, respectively (p \ 0.05). On multivariable analyses of thyroidectomy-specific complications, mFI-5 C0.4 (OR 2.5, 95%-CI 1.4-4.4) and bleeding disorder (OR 4.6, 95%-CI 1.3-16.3) were predictive of hematoma, whereas vessel-sealant device usage (OR 0.4, 95%-CI 0.3-0.7) was protective. mFI-5 C 0.4 (OR 1.5, 95%-CI 1.1-2.2), bleeding disorder (OR 2.8, 95%-CI 1.04-7.8), parathyroid autotransplantation (OR 1.7, 95%-CI 1.2-2.6), and prolonged operative time (OR 1.4, 95%-CI 1.02-1.8) were predictive of RLN palsy. Age was not a significant predictor of hematoma or RLN palsy. Conclusions Patients C80 years old are at increased risk for systemic complications and readmission after thyroidectomy for MNG. Frailty index better risk-stratifies patients than age for thyroidectomy-specific complications.

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

“…Overall operative time was shorter in nonrobust patients, although they were more likely to receive procedures with longer operative time. These findings are contrary to present studies that have demonstrated a positive association with frailty and increased operative time in operations including cholecystectomies, thyroidectomies, and laparoscopic colorectal operations (32,47,48). Tympanomastoidectomy, mastoidectomy, revision mastoidectomy, and cochlear implants were more common in nonrobust patients, whereas tympanoplasty was more common in robust patients.…”

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

“…It would appear that some elderly patients still have a good prognosis, so it seems to be inappropriate to assess the prognosis and make a medical decision simply based on age. Some recent studies suggest that frailty provides better risk stratification for post-operative complications than chronological age [ 26 , 27 ]. Therefore, it has been suggested that screening of frailty may be suitable for detecting older persons at increased risk of adverse outcomes [ 28 – 30 ].…”

Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the U.S. national inpatient sample

“…The effects of frailty in patients receiving thyroidectomy have been investigated by other authors, reporting surgeries performed for benign thyroid conditions mostly [14][15][16]. Among patients with multimodal goiter who underwent thyroidectomy, the frailty index provided more reliable risk assessment than age for complications associated with thyroidectomy [14]. In the present study, frailty was independently associated with increased risk of having medical complications, surgical complications and prolonged length of stay among both older (> = 65 years old) and younger (< 65 years old) patients.…”

“…Prior studies have investigated the effects of frailty on patients undergoing surgery for a broad range of thyroid disease [14][15][16]. Frailty was more predictive of postthyroidectomy systemic complications than age in older adults with multimodal goiter [14]. In common ambulatory general surgery operations including thyroid surgeries, frailty was associated with increased perioperative morbidity independent of age [15].…”