B. Khoraminejad1, S. Sakowitz1, S. Bakhtiyar1, A. Verma1, J. Madrigal1,2, P. Benharash1,2, J. Wu3 1David Geffen School Of Medicine, University Of California At Los Angeles, Cardiovascular Outcomes Research Laboratories, Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Los Angeles, CA, USA 3David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Endocrine Surgery, Los Angeles, CA, USA
Introduction: As incidence of thyroid pathology increases with age, the rapid growth of the octogenarian population presents new challenges for thyroid surgeons. Previous studies have reported conflicting post-thyroidectomy outcomes and complication rates among this age group. Using a nationally representative cohort, this study sought to evaluate trends and outcomes of thyroidectomy among octogenarians.
Methods: This population-based, retrospective study identified all adult patients ≥55 years who underwent inpatient thyroidectomy using the 2010-2019 National Inpatient Sample. Patients age ≥80 were classified as Octogenarian. Adjusted Wald, Chi-square, and Mann Whitney U tests were applied, as appropriate. Cuzick's test (nptrend) was used to assess significance of temporal trends. The primary outcome was any in-hospital complication; secondary outcomes included in-hospital mortality, resource utilization, and non-elective readmission. Multivariable models were built to evaluate independent associations between octogenarian status and perioperative outcomes of interest.
Results:
Our study included 115,132 adult thyroidectomy patients, of which 8,726 (7.6%) were Octogenarians. The proportion of Octogenarian patients increased over the study time course, from 7.7% (2010) to 8.8% (2019) (nptrend<0.001).
On average, Octogenarians were less frequently female (70.5 vs 72.5%, p=0.01) and presented with a higher Elixhauser comorbidity index (3 [2-4] vs 2 [1-3]), as compared to non-octogenarians. Octogenarian patients more commonly underwent thyroidectomy for thyroid cancer (40.6 vs 32.2%, p<0.01).
After risk adjustment for relevant factors, including malignant versus benign disease, extent of operation, and comorbidities, the Octogenarian cohort was associated with greater odds of experiencing perioperative complications overall (AOR 1.26, 95%CI 1.12-1.42). Octogenarian status was linked with greater odds of respiratory complications (AOR 1.65, 95%CI 1.28-2.12), acute kidney injury (AOR 1.75, 95%CI 1.14-2.69), dysphagia (AOR 1.22, 95%CI 1.02-1.46), and laryngeal edema (AOR 1.98, 95%CI 1.03-3.80). No difference in odds of vocal paralysis (AOR 1.13, 95%CI 0.90-1.40), hypocalcemia (AOR 1.18, 95%CI 0.97-1.43), or stridor (AOR 1.24, 95%CI 0.77-1.98) was observed. Further, Octogenarian status was not associated with any difference in odds of in-hospital mortality, hospitalization expenditures, readmission within 30 days, or reoperation relative to non-Octogenarians.
Conclusion: Octogenarian status is independently associated with greater morbidity after thyroid operations. Patients over 80 should be counseled about increased perioperative risk when discussing surgical versus nonsurgical treatments for thyroid disease.
