Preoperative Risk Index Among Patients Undergoing Thyroid or Parathyroid Surgery

Abstract

IMPORTANCE Frailty represents a multidimensional syndrome that is increasingly being used to stratify risk in surgical patients. Current frailty risk models are limited among those undergoing thyroid or parathyroid surgery. OBJECTIVE To develop and compare preoperative risk indices to determine factors associated with short-term major postoperative adverse events in patients undergoing thyroid or parathyroid surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated 154 895 patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent thyroid or parathyroid surgery from January 1, 2007, to December 31, 2016.EXPOSURES Preoperative frailty-related and surgical factors from a derivation cohort were evaluated using simple and multiple logistic regression. Variables potentially associated with postoperative adverse events were subsequently combined into a personalized preoperative Cervical Endocrine Surgery Risk Index (CESRI) and compared with existing risk models using the validation cohort. MAIN OUTCOMES AND MEASURESComposite variable of any major postoperative adverse event, including death, within 30 days of surgery. RESULTS Of the 154 895 operations reviewed, 3318 patients (2.1%; 2296 women and 1022 men; mean [SD] age, 56.1 [15.6] years) experienced a major postoperative adverse event, with 163 deaths (0.1%). Older age (age, Ն80 years: odds ratio [

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].…”

“…Evidence indicates that frailty assessment using riskstratification tools are of particular help in understanding risks associated with individual older adult patients undergoing emergent general surgery as well as to assist with postoperative management and improve geriatric- The significance value is shown in bold a Multivariate analysis was adjusted for age, gender, race, household income, insurance status/primary payer, admission type, procedure type, required cervical LN dissection, metastasis to the lungs, metastasis to the bone, smoking, overweight and obesity, CCI and hospital characteristics centered outcomes [23]. Preoperative risk indices for frailty are being used more and more in patient undergoing thyroid and parathyroid surgery to predict major adverse events, including death with 30 days of surgery [16]. The present study defined frail and non-frail groups based on 10 clusters of frailty-defining diagnoses that comprise the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnosis indicator, a binary variable that uses ICD-9 codes assigned during admission [18,19].…”

“…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]. A preoperative risk index based on multidimensional framework also incorporated frailty as a major component and was found acceptable to determine major adverse events after thyroid or parathyroid surgery, whereas not for malignancy specifically [16].…”

Perioperative considerations in nonagenarians

“…We do acknowledge that other frailty, morbidity, and mortality calculators do exist, some of which are specific to certain subspecialties of surgery, such as urology, head and neck surgery, surgical oncology, orthopedic surgery, colorectal surgery, cardiothoracic surgery, and neurosurgery. Surgical subspecialty risk calculators and frailty scores have outperformed generalized surgical risk calculators upon direct comparison [ 13 , 16 , [18] , [19] , [20] , [21] , [22] ]. The 5-element modified frailty index, which includes diabetes, chronic obstructive pulmonary disease, hypertension requiring medication, congestive heart failure, and functional status, has been found to be a strong predictor of adverse postoperative events [ 23 ].…”