Thyroid surgery outcomes in octogenarians: A national analysis

Sara Sakowitz; Syed Shahyan Bakhtiyar; Baran Khoraminejad; Shayan Ebrahimian; Josef Madrigal; Peyman Benharash; James Wu

doi:10.1016/j.surg.2023.02.003

Thyroid surgery outcomes in octogenarians: A national analysis

Surgery. 2023 Jul;174(1):52-58. doi: 10.1016/j.surg.2023.02.003. Epub 2023 Apr 11.

Authors

Sara Sakowitz¹, Syed Shahyan Bakhtiyar², Baran Khoraminejad³, Shayan Ebrahimian³, Josef Madrigal⁴, Peyman Benharash⁴, James Wu⁵

Affiliations

¹ Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA. Electronic address: https://twitter.com/sarasakowitz.
² Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO. Electronic address: https://twitter.com/Aortologist.
³ Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA.
⁴ Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA.
⁵ Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA. Electronic address: JamesWu@mednet.ucla.edu.

PMID: 37055292
DOI: 10.1016/j.surg.2023.02.003

Abstract

Background: The incidence of thyroid pathology increases with age. Yet octogenarians may face increased rates of complications after thyroid surgery. Using a nationally representative cohort, we evaluated the outcomes of thyroidectomy among octogenarians.

Methods: All patients ≥55 years who underwent inpatient thyroidectomy were identified using the 2010 to 2020 National Readmissions Database. Patients ≥80 years were classified as octogenarians (others: nonoctogenarians). Multivariable models were built to evaluate independent associations between octogenarians and key clinical and financial outcomes.

Results: Of 120,164 hospitalizations, 9,163 (7.6%) were octogenarians. The proportion of octogenarians undergoing thyroidectomy increased from 7.7% (2010) to 8.7% (2020) (nptrend <0.001). Octogenarians were more frequently female (72.1 vs 70.5%, P < .001), presented with a higher Elixhauser comorbidity index (3 [2-4] vs 2 [1-3], P < .001), and more commonly faced thyroid cancer (41.3 vs 32.7%, P < .001). After risk adjustment, octogenarians were associated with greater odds of experiencing any perioperative complication (adjusted odds ratio 1.36, 95% confidence interval 1.25-1.48). Octogenarians were further linked with greater odds of respiratory (adjusted odds ratio 1.82, 95% confidence interval 1.52-2.17) and renal complications (adjusted odds ratio 1.90, 95% confidence interval 1.45-2.49), dysphagia (adjusted odds ratio 1.51, 95% confidence interval 1.33-1.72), laryngeal edema (adjusted odds ratio 2.03, 95% confidence interval 1.30-3.18), vocal cord paralysis (adjusted odds ratio 1.79, 95% confidence interval 1.53-2.09), and stridor (adjusted odds ratio 1.42, 95% confidence interval 1.01-2.00). No difference in hypocalcemia was observed. Furthermore, octogenarians demonstrated an increased likelihood of in-hospital mortality (adjusted odds ratio 6.34, 95% confidence interval 3.11-12.53), hospitalization expenditures (+$910, 95% confidence interval +$420-1,400), and nonelective readmission within 30 days of discharge (adjusted odds ratio 1.54, 95% confidence interval 1.32-1.79).

Conclusion: Octogenarians are associated with greater morbidity after thyroidectomy. Patients ≥80 years should be counseled about increased perioperative risk when discussing surgical versus nonsurgical treatments for thyroid disease.

MeSH terms

Aged, 80 and over
Female
Hospitalization
Humans
Octogenarians*
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Thyroid Gland*
Thyroidectomy / adverse effects