Outcomes of thyroidectomy from a large California state database

Weiss, Anna; Parina, Ralitza; Tang, Jessica; Brumund, Kevin T.; Chang, David C.; Bouvet, Michael

doi:10.1016/j.amjsurg.2015.08.011

Cited by 34 publications

(30 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additional limitations of the 3 cost-effectiveness studies described above include that none consider indirect costs due to time lost from work and impacted responsibilities of daily living as a result of surgery and its recovery. Neither Lee et al ( 66 ) nor Wu et al ( 48 ) include costs for potential perioperative death, occurring in up to three in 1000 patients ( 8 , 69 , 70 , 71 , 72 , 73 , 74 ). The study methodologies may underestimate the impact of complications on the patient, including voice outcomes ( 75 , 76 ) and hypoparathyroidism ( 77 ).…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…Complications from thyroid surgery include, but are not limited to, hypothyroidism, voice changes, vocal cord dysfunction, hypocalcemia (temporary and permanent), tracheostomy, hematoma, infection, hospital readmission, and death. Complications are highest in patients older than 65 years of age, and when the procedure is performed outside of high-volume thyroidectomy hospitals ( 8 ). Among cytologically indeterminate nodules, patient clinical factors, ultrasound characteristics ( 9 ), additional cytological subcategorization or second opinion, and repeat FNAB have been unable to reliably identify a significant fraction of benign nodules to safely avoid surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making

Kloos

2017

Mirt

View full text Add to dashboard Cite

Thyroid fine-needle aspiration biopsy results are cytologically indeterminate in 15-30% of cases. When these nodules undergo diagnostic surgery, approximately three-quarters are histologically benign. These unnecessary surgeries diminish quality of life, generate complications, and increase healthcare costs. The Afirma gene expression classifier (GEC) is validated to pre-operatively identify cytologically indeterminate nodules likely to be truly benign so that surgery can be avoided. Its performance is supported by robust multicenter prospective and blinded clinical validation studies, and supported by extensive independent clinical utility publications which show a marked reduction in surgery among patients with benign Afirma GEC results. To rule-out cancer and avoid unnecessary diagnostic surgery, Afirma’s quality and depth of validation stand alone. The accuracy of a benign result is the negative predictive value (NPV). Afirma achieves an NPV ≥94% among cytologically indeterminate nodules (Bethesda III or IV). Thirteen clinical utility studies describing 1468 GEC benign patients demonstrate that few Afirma GEC benign nodules undergo surgery, including after 3 years of follow-up. With a specificity of 52%, over half of the truly benign nodules with indeterminate cytology receive a benign GEC result. High test sensitivity is critical to safely rule out cancer. The Afirma GEC’s 90% sensitivity means that regardless of the pre-test risk of malignancy, 90% of all malignant nodules are GEC suspicious. The Afirma GEC has transformed patient care. Where the majority of cytologically indeterminate patients were once operated to determine if the nodule was benign or malignant, now nearly half of these surgeries can be avoided.

show abstract

Section: Cost-effectivenessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making

Kloos

2017

Mirt

View full text Add to dashboard Cite

show abstract

“…The reported blood loss was ≤500 mL in the vast majority of patients (98%). High-volume hospitals or those that perform more than four operations daily11 generally report lower rates of mortality and morbidity associated with thyroidectomy compared to hospitals with a lower surgical volume 12,13. None of the included operations in our study was associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

<p>Utilization of cross-matched blood in elective thyroid and parathyroid surgeries: a single-center retrospective study</p>

Alahmari¹,

Marzouki²,

Alsallum³

et al. 2019

IJGM

View full text Add to dashboard Cite

BackgroundHospital blood banks face the common challenge of maintaining an adequate supply of blood products to serve all potential patients while minimizing the need to discard expired blood products. This study aimed to determine the risk of blood transfusion during elective thyroid and parathyroid surgery and potential factors related to blood loss and risk of transfusion in these cases.MethodsThe study included all thyroid and parathyroid surgeries performed at King Abdulaziz University Hospital between January 2015 and December 2017. After exclusion of patients with incomplete data, 179 patients with complete data who had undergone thyroid and parathyroid surgery were analyzed.ResultsOf the179 patients included in this study, 33 (18.4%) were male. Overall, patients had a mean age and body-mass index of 44.55±13.67 years and 27.66±5.38 kg/m2, respectively. The mean duration of surgery was 168.48±90.69 minutes. None of the patients had a history of previous radiotherapy, bleeding disorder, or blood transfusion. Benign goiter was the most common finding (n=78, 43.6%), followed by papillary carcinoma (n=49, 27.4%). During surgery, most patients (n=136, 76.0%) experienced minimal blood loss. None of the patients in our cohort (n= 179) required any blood transfusion or products.ConclusionIn this study, we aimed to audit the surgical blood-ordering and -transfusion practices associated with elective thyroid and parathyroid surgeries at our institution. These practices are intended to balance the availability of blood products with the avoidance of unnecessary wastage. In our study of patients who underwent elective thyroid and parathyroid surgeries, parathyroid surgeries, none required blood transfusion.

show abstract

“…6 A retrospective review of 106 773 thyroidectomy patients in California reported a 1.62% tracheostomy rate. 7 With an increased awareness of the true scale of VFP following thyroidectomy comes an appreciation of its associated morbidity and mortality. A national database study of 43 515 patients revealed that VFP doubled the risk of hospital admission for pneumonia, which led to over three times the risk of dysphagia and a 20-fold risk of gastrostomy or tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

et al. 2020

View full text Add to dashboard Cite

Background: Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group. Methods: A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach. Results: Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery. Conclusion: After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.

show abstract

Outcomes of thyroidectomy from a large California state database

Cited by 34 publications

References 20 publications

Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making

Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making

<p>Utilization of cross-matched blood in elective thyroid and parathyroid surgeries: a single-center retrospective study</p>

Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment

Contact Info

Product

Resources

About