Thyroidectomy in older adults: an American College of Surgeons National Surgical Quality Improvement Program study of outcomes

Sahli, Zeyad T.; Ansari, Ghedak; Gürakar, Merve; Canner, Joseph K.; Segev, Dorry L.; Zeiger, Martha A.; Mathur, Aarti

doi:10.1016/j.jss.2018.03.057

Cited by 21 publications

(20 citation statements)

References 20 publications

(27 reference statements)

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“…Postoperative complication rates in our cohort corroborate with those reported previously in two studies based on the NSQIP database [19, 20]. In fact, the postoperative complication rate in inpatients after thyroid surgery was reported to be 5% as compared to 3% in outpatients [21]. Independent predictors of morbidity in patients undergoing thyroid surgery include age >70, non-Caucasian race, dependent functional status, and comorbidities, such as diabetes, chronic obstructive pulmonary disease, hypertension, dialysis, congestive heart failure, bleeding disorders, and preoperative sepsis.…”

Section: Discussionsupporting

confidence: 90%

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Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

Latifi

Gachabayov

Gogna

et al. 2019

Journal of Thyroid Research

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Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien–Dindo class 3–5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p < 0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions.

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Section: Discussionsupporting

confidence: 90%

“…In addition to them, malignant thyroid disease and surgical approach (total thyroidectomy) were found to be independent predictors of postoperative morbidity [19]. Octogenarians were found to have 2.7 times higher risk of postoperative morbidity [21]. Length of hospital stay is controversial in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

Latifi

Gachabayov

Gogna

et al. 2019

Journal of Thyroid Research

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“…Although high‐volume thyroid surgeons report relatively low surgical complication rates of 1% to 3%, approximately 26% to 81% of patients undergo surgery with low‐volume surgeons whose complication rates generally are much higher, including hypothyroidism, clinically severe hypocalcemia/hypoparathyroidism, recurrent laryngeal nerve injury, and, less commonly, infection and bleeding . Higher surgical complication rates have been reported among the elderly, who are heavily represented in the thyroid nodule population. These findings highlight the burden of diagnostic surgery among patients with cytologically indeterminate nodules and the need for change.…”

Section: Introductionmentioning

confidence: 99%

Extending expressed RNA genomics from surgical decision making for cytologically indeterminate thyroid nodules to targeting therapies for metastatic thyroid cancer

Ali

Siperstein

Sadow

et al. 2019

Cancer Cytopathology

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The Afirma Genomic Sequencing Classifier (GSC) is a rule‐out test for malignancy/noninvasive follicular thyroid neoplasms with papillary‐like nuclear features among patients with Bethesda category III/IV nodules, whereas the complimentary Xpression Atlas provides genomic insights from a curated panel of 511 genes among GSC suspicious and Bethesda category V/VI nodules. Together, they facilitate personalized treatment decisions based on genomic insights derived from the transcriptome of the biopsied target and extend the diagnostic and therapeutic reach of cytopathologists and fine‐needle aspiration biopsy sample collection.

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“…The relatively greater impact of thyroid surgery on speech and swallowing in the elderly is not unexpected, and may be related to more advanced thyroid cancer, as well as age-related voice and swallowing changes in these populations. 21,[29][30][31] Preoperative laryngeal exam was uncommon, despite promotion as best practice. 32 Its use consistently, however, may improve preoperative counseling and facilitate rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…Older patients were no more likely to report treatment‐related complications than younger patients; however, older adults were more likely to report problems with speech and swallowing as the treatment‐related complication. The relatively greater impact of thyroid surgery on speech and swallowing in the elderly is not unexpected, and may be related to more advanced thyroid cancer, as well as age‐related voice and swallowing changes in these populations 21,29‐31 . Preoperative laryngeal exam was uncommon, despite promotion as best practice 32 .…”

Section: Discussionmentioning

confidence: 99%

What the thyroid cancer patient wants to know: ThyCa survey by the American Head and Neck Society Endocrine Surgery Section

Dhillon

Karcioglu

Bloom³

et al. 2020

Head & Neck

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Objective To survey a large cohort of thyroid cancer survivors from ThyCa on information needs and expectations of their treatment to better understand the pretreatment counseling, information, and support needs of this population. Methods Anonymous survey of thyroid cancer survivors. Results One thousand one hundred twenty‐four patients with thyroid cancer participated in the survey. Three hundred sixty‐two (37.44%) reported not having had a full understanding of their treatment plan and 407 (46.41%) reported that their thyroid cancer treatment did not conform to expectations. Patients diagnosed at younger ages were significantly more likely to report inadequate understanding of the treatment, failure of treatment to meet expectations, and call for greater attention to psychological well‐being. Older patients were more likely to report unexpected effects on speech and swallowing. Regardless of age, patients most frequently called for greater attention to management of energy levels (endorsed by 61% of respondents), psychological well‐being (50%), and weight changes (48%). Conclusions Improvements are needed in age‐specific communication of thyroid cancer diagnosis and treatment.

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Thyroidectomy in older adults: an American College of Surgeons National Surgical Quality Improvement Program study of outcomes

Abstract: Patients aged ≥65 y have significantly higher rates of overall complications. In addition, patients aged ≥80 y have higher rates of total and thyroidectomy-related readmissions and extended length of hospital stay.

Cited by 21 publications

References 20 publications

Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

Extending expressed RNA genomics from surgical decision making for cytologically indeterminate thyroid nodules to targeting therapies for metastatic thyroid cancer

What the thyroid cancer patient wants to know: ThyCa survey by the American Head and Neck Society Endocrine Surgery Section

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