V. Papoian1, F. P. Marji1, J. E. Rosen1, N. M. Carroll1, E. A. Felger1 1Georgetown University Medical Center,Surgery,Washington, DC, USA
Introduction:
Thyroid surgery is becoming more common in the elderly as the proportion of the population that is elderly continues to grow. Unfortunately, there are limited studies evaluating the complication rates of thyroidectomy in elderly patients. We aim to evaluate the relative risk of morbidity from thyroidectomy in patients greater than 75 years of age.
Methods:
Medical records were used to identify all patients older than 75 years undergoing thyroidectomy between 2001 and 2018 in a multi-hospital network. A matched control group was selected with use of a propensity score based on gender, ethnicity, type of surgery, insurance status and comorbidities. The Charlson Comorbidity Index was used to quantify comorbidities. Total complications included both thyroid surgery specific complications, including recurrent laryngeal nerve injury or dysfunction, dysphagia, symptomatic hypocalcemia, hematoma, and wound complications, in addition to systemic complications. Analysis was performed with the use of chi-square analysis and two sample t-tests. A subgroup analysis was performed for patients older than 80 years of age.
Results:
We identified 313 patients over the age of 75 years with a propensity score matched group of 313 patients. There was no difference between the percent female (73% vs 73%, p=0.92), race composition (p=0.91), insurance status (p=0.99), percent undergoing total thyroidectomy (84% vs 84%, p=0.91) and Charleston Index (2.6 vs 2.69, p=0.70) of the two groups. There was no statistically significant difference between post operative emergency room visits (7% vs 6%, p=0.61), readmissions (11.5% vs 8.6%, p=0.18), cardiovascular (1.3 vs 0.6%, p=0.42), pulmonary (3.2 vs 0.9%, p=0.07), or neurologic complications (1.0 vs 0.3%, p=0.34). No re-operations were noted in either group. Elder patients did have a longer length of stay (2.64 vs 1.29 days, p<0.01). The findings for the sub-analysis for patients over the age of 80 showed comparable findings to the entire cohort.
Conclusion:
Elderly patients did have a longer length of stay when compared to a matched younger population. Although, there was a trend with higher complication rates in the elderly, those differences did not reach statistical significance. The current results indicate that thyroidectomy in the elderly is as safe as it is in younger patients when accounting for comorbidities.