S. Kurumety1, I. Helenowski1, S. Goswami1, B. Peipert1, S. Yount2, C. Sturgeon1 2Feinberg School Of Medicine – Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA 1Feinberg School Of Medicine – Northwestern University,Department Of Surgery,Chicago, IL, USA
Introduction: There is a paucity of patient-reported data on thyroidectomy scar perception. The magnitude and duration of the impact of thyroidectomy scar on quality of life (QOL) is not known. We hypothesized that age, sex and race would predict scar perception, and that worse scar perception would correlate with lower?QOL. Furthermore, we hypothesized that over time, scar perception would improve.
Methods: Adults >18 years who had undergone thyroidectomy for cancer?(n=1743)?were recruited from a support group and surveyed online. Demographics, clinical characteristics, and treatment history were assessed. Scar perception was scored on a 5-point Likert scale.?QOL was evaluated via PROMIS-29. Respondents were grouped and compared based on their responses. The relationship between scar perception, patient characteristics, and QOL were?analyzed?with univariable and multivariable?models. Kruskal-Wallis, Fisher’s exact test, and cumulative logistic regression were used to compare?categorical variables. The relationship?between PROMIS domains and scar perception?were?analyzed using Spearman partial correlation coefficients?(r)?adjusted for age and years after surgery.?Holms-Bonferroni was used to correct for multiple comparisons.
Results: Increasing age?was associated with?better?scar perception (OR 0.975/year; 95% CI 0.967-0.983; p<0.001).?71% of respondents age >45?years?reported no concern over scar, compared to only 53% of respondents?<45;?p < 0.0001. Increased time since surgery?was?also associated with?improved?scar perception (OR 0.962/year; 95% CI 0.947-0.977; p<0.0001), but there was no statistically significant difference between current and baseline neck appearance >2 years after surgery. On multivariable analysis, age >45 years (OR 0.65; [0.52-0.81] p=0.0001), >2 years since surgery (OR 0.57; 95% CI 0.46-0.70; p<0.0001), and higher self-reported QOL (OR 0.77; 95% CI 0.67-0.89; p=0.0003) were independent predictors of better self-reported scar appearance. In patients <2 years after surgery (n=568), the PROMIS domains of anxiety (rs=0.19; p<0.0001), depression (rs=0.21; p<0.0001), social function (rs=-0.18; p<0.0001), and fatigue (rs=0.21; p<0.0001) had weak but statistically significant associations with worse scar appearance. Sex and race/ethnicity were not associated with scar perception.
Conclusions: This is the largest study conducted in the U.S to evaluate scar perception after thyroidectomy, and the first to use PROMIS measures.??Age >45, >2 years since surgery, and higher self-reported QOL were independent predictors of better scar perception.??There was no significant difference between perception of current and baseline neck appearance in the group of respondents >2 years after thyroidectomy. There was a weak correlation between scar perception?and?PROMIS domains in patients who had surgery within 2 years. The impact of thyroidectomy scar on QOL appears to be mild and transient and plateaus after 2 years.