Thyroid surgery for elderly patients: are they at increased operative risks?

Sze-How Ng,Kai-Pun Wong,Brian Hung-Hin Lang

doi:10.1155/2012/946276

Sze-How Ng, Kai-Pun Wong + Show 1 more

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https://doi.org/10.1155/2012/946276

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Abstract

An increasing elderly population, a rising incidence of differentiated thyroid carcinoma (DTC), and a rising incidence of benign nodular disease with age are all contributing to a rise in thyroid operations for the elderly. Literature review on the outcome and safety of thyroid surgery in elderly patients has been filled with conflicting results and this subject remains controversial. Although most single-institution studies conducted by high-volume surgeons did not find significant differences of complication rates in elderly when compared with younger cohorts, they often lacked the power necessary to identify subtle differences and suffered from various selection and referral biases. Recent evidence from large population-based studies concluded that thyroid surgery in the elderly was associated with higher complication rates. One of the major contributing factors for the increased complication rate was because most elderly patients suffered from many preexisting comorbidities. Therefore, elderly patients who have abnormal thyroid findings should complete a thorough preoperative workup and better postoperative care after undergoing any thyroid surgery. Furthermore, these high-risk patients would benefit if they could be referred to high-volume, specialized surgical units early. In this systemic review, we aimed to evaluate different issues and controversies in thyroidectomy for elderly patients.

Highlights

Both benign and malignant thyroid diseases occur commonly in the elderly population and this is partly related to the fact that the incidence of thyroid nodules increase with age [1]
We aimed to evaluate both safety and surgical outcome on thyroid surgery in elderly patients
Shah et al prospectively evaluated seventy-six patients with differentiated thyroid carcinoma (DTC) and reported that patients with cancer experienced a greater drop in Quality of Life (QOL) during the first 6 months following surgery when compared with patients with benign disease (P < 0.03)

Summary

Introduction

Both benign and malignant thyroid diseases occur commonly in the elderly population and this is partly related to the fact that the incidence of thyroid nodules increase with age [1]. Since it is generally perceived that the elderly may have increased operative risks because of the presence of increasing number of comorbidities, a more conservative or nonoperative approach is often adopted [3] As a result, those patients who really undergo thyroid surgery generally would normally have a much “stronger” or more urgent indication, such as those with more severe symptoms from their thyroid disease (e.g., compressive symptoms) or those with suspected or proven malignancy, than their younger counterparts. Over the last 10 years, major advances have occurred in general and endocrine surgery, anesthesia, perioperative care, instrumentation, and technology and they tend to reduce the overall operative risk, allowing greater proportion of elderly patients to undergo elective surgery [9].

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