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A Population-Based Prospective Cohort Study of Complications after Thyroidectomy in the Elderly.
MedLine Citation:
PMID:  22419716     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context:Data on the risk of postthyroidectomy complications in elderly patients are sparse, unclear, and conflicting.Objective:We sought to use a population-based cohort to determine whether thyroid operations in the elderly are as safe as those done in younger patients.Design:This was a prospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2008, with 30-d postoperative follow-up.Setting:The American College of Surgeons National Surgical Quality Improvement Program data set contains operative cases from a nationwide sampling of academic and community-based as well as high-volume and low-volume hospitals.Patients:All thyroidectomy and parathyroidectomy patients reported to the database during the study period were included in the analysis resulting in an experimental cohort of 7915 thyroidectomy cases and a control cohort of 3575 parathyroidectomy cases.Main Outcome Measures:We aggregated 83 complications into the following outcome measures: urinary tract infection, wound infection, systemic infection, cardiac complications, pulmonary complications, 30-d mortality, and total hospital length of stay.Results:Increased age is a risk factor for significant pulmonary, cardiac, and infectious complications after thyroidectomy. Elderly patients are twice as likely (odds ratio 2.1, 95% confidence interval 1.4-3.3), and the superelderly are 5 times as likely (odds ratio 4.9, 95% confidence interval 2.5-9.6) to have a complication compared with their young counterparts. Preexisting comorbidities are effect modifiers and increase the risk of complications even further.Conclusions:Elderly thyroidectomy patients are at increased risk for major systemic complications. A systematic approach to the care of elderly thyroidectomy patients is necessary to minimize their risk of serious postoperative complications.
Authors:
Raymon H Grogan; Elliot J Mitmaker; Jimmy Hwang; Jessica E Gosnell; Quan-Yang Duh; Orlo H Clark; Wen T Shen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-14
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  -     ISSN:  1945-7197     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Endocrine Surgery Research Program (R.H.G.), Department of Surgery, Section of Endocrine Surgery, University of Chicago Medical Center, Chicago, Illinois 60637; and Biostatistics and Computational Biology Core (J.H.), Helen Diller Family Comprehensive Cancer Center, and Department of Surgery (E.J.M., J.E.G., Q.-Y.D., O.H.C., W.T.S.), Section of Endocrine Surgery, University of California, San Francisco, San Francisco, California 94143.
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