Elderly patients can safely undergo thyroid surgery with careful preoperative screening, according to a study published in JAMA Otolaryngology—Head & Neck Surgery (doi:10.1001/archoto.2009.138). Thyroid surgery was found to be no more dangerous in elderly patients (older than 65 years) than in youthful patients (age 21 to 35 years).
Readmission rates for outpatients were less than 1%, according to an analysis of 1311 thyroidectomy procedures, including 1026 outpatient cases from May 2006 to November 2013 by a single surgeon at an academic medical center. Though the percentage of cases performed on an outpatient basis climbed from 59.7% to 92.3%, and their complexity increased, readmission rates did not increase.
When the same researchers compared the results for older and younger patients, outpatient thyroid surgery was found to be safe for even the oldest patients. The researchers compared a control group with a mean age of 33 years, 201 patients with a mean age of 70 years, and 16 patients with an average age of nearly 83 years.
“We have continued to refine our approach, evolving from one in which patients were kept in the hospital just under 24 hours to sending a handful a patients home right after surgery,” said David J. Terris, MD, otolaryngologist at the Medical College of Georgia at Augusta University and surgical director of the university’s Thyroid Center.
“The process has been tweaked, and we are slowly growing the outpatient numbers. We have looked at things like how we manage the medicines, especially the calcium supplements, and how we manage the instructions we give caregivers,” Terris added. “Now, we’ve said: We are comfortable with this. And patients love it.”
Unrelated health problems, such as hypertension and diabetes, are much more common in elderly patients, along with thyroid disease that is generally more aggressive. Still, complications rates were 5% to 6% for all the age groups.
“Despite having a higher incidence of comorbid conditions, our older patients did just as well when we sent them home after the operation,” Terris said. Terris explained that patients are more likely to be treated as inpatients if they have severe unrelated health problems or lack a good support system at home.
The researchers stated that elderly patients should obtain cardiac clearance as needed, but they pointed out that cardiac complications largely occur in patients undergoing major abdominal, thoracic, and vascular surgery, rather than surgery using minimally invasive approaches.