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Thyroid surgery in the elderly: a surgical cohort

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Abstract

Purpose

The need for thyroid surgery in the elderly is rising due to an ageing population, the liberal use of imaging studies, and the increasing prevalence of thyroid nodules and cancer with age. Data on surgical outcomes in this population are scarce and conflicting, but essential to assess safety of short-stay surgery. This study aims to compare surgical outcomes by age.

Methods

All consecutive patients undergoing thyroid surgery from January 2010 to July 2021 in a large tertiary referral centre for endocrine surgery were included in this surgical cohort. The indication for surgery, surgical morbidity (hypocalcaemia, bleeding, recurrent laryngeal nerve (RLN) palsy), and length of hospital stay were assessed in three age groups (young: 18-64y, older: 65-74y, and the elderly: 75 years and older).

Results

A total of 2,030 patients (1,499 young, 370 older, and 161 elderly) were included. The indication for surgery was significantly different, with the main indications in the elderly being multinodular goitre (70.2% vs. 47.7% in young patients) and thyroid cancer (9.9% vs. 7.0%). Reintervention for bleeding was more often required in the older (4.6%) and the elderly (2.5%) patients (vs. 1.4%). There was no difference in the proportion of hypocalcaemia or RLN palsy. The length of hospital stay was significantly longer in the elderly (length of stay longer than one day 43.5% vs. 9.8%).

Conclusion

Thyroid surgery in patients aged 75 years and older is a safe procedure with morbidity comparable to younger patients. However, the risk of reintervention for bleeding is higher, rendering ambulatory surgery not advisable.

Trial registration

Researchregistry6182 on October 29th 2020, retrospectively registered.

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Data Availability

Data are only available on request.

References

  1. United Nations, Department of Economic and Social Affairs, Population Division (2019) World Population Ageing 2019: Highlights. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf. Accessed 16 May 2023

  2. World Health Organization (2022) Fact Sheet Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 16 May 2023

  3. Gervasi R, Orlando G, Lerose MA et al (2012) Thyroid surgery in geriatric patients: a literature review. BMC Surg 12 Suppl 1(Suppl 1):S16. https://doi.org/10.1186/1471-2482-12-S1-S16

    Article  PubMed  Google Scholar 

  4. Van Den Heede K, Tolley NS, Di Marco AN et al (2021) Differentiated thyroid cancer: a health economic review. Cancers 13(9):2253. https://doi.org/10.3390/cancers13092253

    Article  PubMed  Google Scholar 

  5. Papoian V, Marji FP, Rosen JE et al (2019) Safety of thyroid surgery in the elderly: a propensity score matched cohort study. J Surg Res 242:239–243. https://doi.org/10.1016/j.jss.2019.04.012

    Article  PubMed  Google Scholar 

  6. Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  7. Passler C, Avanessian R, Kaczirek K et al (2002) Thyroid surgery in the geriatric patient. Arch Surg 137(11):1243–1248. https://doi.org/10.1001/archsurg.137.11.1243

    Article  PubMed  Google Scholar 

  8. Sahli ZT, Ansari G, Gurakar M et al (2018) Thyroidectomy in older adults: an American College of Surgeons National Surgical Quality Improvement Program study of outcomes. J Surg Res 229:20–27. https://doi.org/10.1016/j.jss.2018.03.057

    Article  PubMed  PubMed Central  Google Scholar 

  9. Inversini D, Morlacchi A, Melita G et al (2017) Thyroidectomy in elderly patients aged ≥70 years. Gland Surg 6(5):587–590

    Article  PubMed  PubMed Central  Google Scholar 

  10. Van Slycke S, Gillardin JP, Brusselaers N et al (2013) Initial experience with S-shaped electrode for continuous vagal nerve stimulation in thyroid surgery. Langenbecks Arch Surg 398(5):717–722. https://doi.org/10.1007/s00423-013-1068-3

    Article  PubMed  Google Scholar 

  11. Guarino S, Di Cosimo C, Chiesa C et al (2014) Perioperative care in elderly patients undergoing thyroid surgery. Int J Surg 12(Suppl 2):S78–S81. https://doi.org/10.1016/j.ijsu.2014.08.375

    Article  PubMed  Google Scholar 

  12. Seybt MW, Khichi S, Terris DJ (2009) Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg 135(10):1041–1044. https://doi.org/10.1001/archoto.2009.138

    Article  PubMed  Google Scholar 

  13. Grubey JS, Raji Y, Duke WS et al (2018) Outpatient thyroidectomy is safe in the elderly and super-elderly. Laryngoscope 128(1):290–294. https://doi.org/10.1002/lary.26707

    Article  PubMed  Google Scholar 

  14. Tartaglia F, Russo G, Sgueglia M et al (2014) Total thyroidectomy in geriatric patients: a retrospective study. Int J Surg 12(Suppl 2):S33–S36. https://doi.org/10.1016/j.ijsu.2014.08.386

    Article  PubMed  Google Scholar 

  15. Grogan RH, Mitmaker EJ, Hwang J et al (2012) A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab 97(5):1645–1653. https://doi.org/10.1210/jc.2011-1162

    Article  CAS  PubMed  Google Scholar 

  16. Ríos A, Rodríguez JM, Galindo PJ et al (2005) Surgical treatment for multinodular goitres in geriatric patients. Langenbecks Arch Surg 390(3):236–242. https://doi.org/10.1007/s00423-004-0521-8

    Article  PubMed  Google Scholar 

  17. Mekel M, Stephen AE, Gaz RD et al (2009) Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 146(5):913–921. https://doi.org/10.1016/j.surg.2009.05.004

    Article  PubMed  Google Scholar 

  18. Van Slycke S, Simons AS, Van Den Heede K et al (2021) Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study. Updates Surg 73(4):1–10. https://doi.org/10.1007/s13304-021-01027-1

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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Authors and Affiliations

  1. Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium

    Fien Van den Eynde

  2. Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium

    Fien Van den Eynde, Klaas Van Den Heede & Sam Van Slycke

  3. Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Tomtebodavagen 16, 17165, Stockholm, Sweden

    Nele Brusselaers

  4. Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium

    Nele Brusselaers

  5. Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Nele Brusselaers & Sam Van Slycke

  6. Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium

    Sam Van Slycke

Authors
  1. Fien Van den Eynde
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  2. Klaas Van Den Heede
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  3. Nele Brusselaers
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  4. Sam Van Slycke
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Contributions

All authors (FVDE, KVDH, NB, SVS) contributed to the study conception and design. Material preparation, data collection and analysis were performed by Van den Eynde F, Van Den Heede K and Van Slycke S. The first draft of the manuscript was written by Van den Eynde F which was revised by all other authors (KVDH, NB, SVS). All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fien Van den Eynde.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The prospective data collection was approved by the Ethical Committee of the OLV hospital in 2009.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Van den Eynde, F., Van Den Heede, K., Brusselaers, N. et al. Thyroid surgery in the elderly: a surgical cohort. Langenbecks Arch Surg 408, 254 (2023). https://doi.org/10.1007/s00423-023-02982-6

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