BACKGROUND
Thyroid nodules, both benign and cancerous, are more common in older people. Patients who have thyroid surgery can have complications, such as damage to the vocal cords, low calcium levels, infection and longer lengths of stay in the hospital after surgery. Studies done in the past have tried to figure out if older people who have thyroid surgery are more likely than younger people to suffer those complications but the results were mixed. Some studies showed more complications and some reported no difference.

This study tries to determine if there is a difference in complications of thyroid surgery between patients in their 80s (octogenarians) and younger patients.

THE FULL ARTICLE TITLE
Sakowitz S et al 2023 Thyroid surgery outcomes in octogenarians: A national analysis. Surgery. Epub 2023 Apr 11. PMID: 37055292

SUMMARY OF THE STUDY
The authors studied about 120,000 patients older than 55 who had thyroid surgery in the hospital between 2010 and 2020. The patients were divided in two groups: older than 80 years old and and younger than 80 years old. Almost 8% of the patients were older than 80 years old. The authors took into account other medical problems the patients may have had before the surgery and how frail they were. They looked at complications after the surgery, medical expenses, death, how long they stayed in the hospital and chances of being readmitted within 30 days after having left the hospital.

The death rate was 0.2% or 2 patients for every 1000 patients. The group of patients over 80 years old, as expected, had more medical conditions prior to the surgery and also higher rates of complications after the surgery (31 % for the older group and 22% for the younger group), including about twice the rate of vocal cord injury (resulting in voice problems) and readmissions. The older group was about 6 times more likely to die in the hospital. They also were more likely to have strokes, respiratory and kidney problems than patients in the younger group. Their stay in the hospital was longer and the hospital costs were higher for this older group of patients. Even for those patients that had same day surgery the complications were higher for the older group (infection and local bleeding).

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The good news about this study is that dying after thyroid surgery was very low for all patients. But it also showed that patients older than 80 undergoing thyroid surgery were more likely to have medical complications, death, longer stay in the hospital and higher costs. The decision to recommend thyroid surgery to older patients should be individualized and patients should be informed about their risks.

— Susana Ebner MD

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