Study examines complications of thyroid surgery in older patients

In a study of patients undergoing thyroid surgery performed by a single surgeon, older adults did not appear to have more complications than younger patients, according to a report in October issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

The segment of the U.S. population older than 65 has increased by 90 percent during the past 30 years, according to background information in the article. "As the population ages, surgery is being performed on geriatric patients more frequently on an elective basis than in decades past, for both malignant and benign diseases," the authors write. "Thyroid disorders, particularly those requiring surgical intervention, represent many of the conditions that must be managed, although little has been written about the geriatric patient population and the special challenges they may pose."

Surgery is usually considered more hazardous in older patients, but the increased risk may be due to co-occurring illnesses rather than age alone, the authors note. Melanie W. Seybt, M.D., and colleagues at Medical College of Georgia, Augusta, analyzed data from 86 younger (age 21 to 35, average age 29.5) and 44 older (older than age 65, average age 71.3) patients who underwent thyroidectomy (surgery to remove all or part of the thyroid) performed by a single surgeon between 2003 and 2007. They assessed pathology reports, complications and the need for admission or readmission to the hospital.

No patients in either group died or experienced permanent vocal cord paralysis, and rates of complications were similar. For instance, 12.5 percent of older patients and 11.1 percent of younger patients experienced temporarily low blood calcium levels, and rates of temporary vocal cord paralysis were 2.9 percent among older and 3.9 percent among younger patients.

Older patients did have higher rates of readmission to the hospital (4.5 percent vs. 1.2 percent), but the difference was not statistically significant. None of the readmissions were attributable to an age-related cause; rather, all were due to hypocalcemia (low calcium levels).

"Thyroid surgeons will be faced more often with the prospect of elective thyroid surgery in patients of advanced age as an increasingly aged population emerges and the prevalence of thyroid nodules and thyroid cancer increases. Thyroid surgery in elderly patients is safe and no more dangerous than surgery in youthful patients," the authors conclude. "Careful preoperative management of comorbid [co-occurring] conditions is essential to performing safe thyroidectomy in patients of all ages."

(Arch Otolaryngol Head Neck Surg. 2009;135[10]:1041-1044. Available pre-embargo to the media at www.jamamedia.org.)

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