Thyroid surgery in octogenarians is associated with higher complication rates
Thyroid surgery in octogenarians is associated with higher complication rates
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DOI：
10.1016/j.surg.2009.05.004
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发表时间：
2009-11-01
期刊：
影响因子：
3.8
通讯作者：
Parangi, Sareh
中科院分区：
文献类型：
--
作者：
Mekel, Michal;Stephen, Antonia E.;Parangi, Sareh
背景资料。甲状腺结节的发生率随着年龄的增长而增加，有关老年患者甲状腺手术风险的信息很少。这项研究的目的是确定80例患者的甲状腺手术是否与较高的并发症发生率相关。在2001年7月至2007年10月在同一机构接受甲状腺手术的3568名患者中，对90名连续80年的患者的记录进行了回顾，并与同期随机选择的242名年龄在18-79岁的甲状腺手术患者进行了比较。临床变量包括年龄、性别、术前诊断、胸骨后部分、既往手术、最终病理、住院时间、合并症、美国麻醉学家协会(ASA)评分、体重指数、术后并发症和死亡率。手术前指征包括良性疾病51%对39%，疑似恶性肿瘤19%对26%，怀疑滤泡肿瘤30%对35%。80岁以上的老年人在最终病理上有20%的恶性程度，而年轻组为27%(P=NS)。80岁以上组的总体并发症发生率为24%，而年轻组为9%(P<；.001)。男性性别和ASA>；=3是甲状腺手术后围手术期并发症的独立影响因素，而年龄不是独立的影响因素。年龄=80岁与甲状腺手术后较高的发病率有关，尽管不是独立的。对于疾病进展风险较高的患者，可以建议早期手术干预，而对于其他患者，则可以建议采取非手术的随访策略。(《外科手术》2009；146：913-21。)
Background. The incidence of thyroid nodules increases with age and little information is available regarding the risks of thyroid surgery in elderly patients. The aim of this study was to determine whether thyroid surgery in patients : 80 is associated with higher complication rates.Methods. Out of 3,568 patients undergoing thyroid surgery between July 2001 and October 2007 at a single institution., the records of 90 consecutive patients 80 years were reviewed retrospectively and compared with a cohort of 242 randomly selected patients aged 18-79, who underwent thyroid surgery during the same time period. Clinical variables included age, gender, pre-operative diagnosis, substernal component, previous surgery, final pathology, length of stay, comorbidities, American Society of Anesthesiologists (ASA) score, body mass index, postoperative complications, and mortality.Results. Preoperative indications for surgery included benign disease in 51% vs 39%, suspected malignancy in 19% vs 26%, and suspected follicular neoplasms in 30% vs 35% in the octogenarian patient group (>= 80 years old) vs the younger patient cohort (P = NS). Octogenarians had 20% significant malignancy on final pathology vs 27% in the younger cohort (P = NS). The overall complication rate in the octogenarian group was 24% vs 9% in the younger cohort (P < .001). Male gender and ASA >= 3 were found to be independent fisk factors for Perioperative complications after thyroid surgery, while age alone was not.Conclusion. Age >= 80 is associated with higher morbidity after thyroid surgery, although not independently. Earlier operative intervention may be advised in those at high risk for disease progression, whereas follow-up strategies without operation may be advised for others. (Surgery 2009;146:913-21.)