Faculty Collaboration Database

A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg 2008 Jun;206(6):1097-105

Date

05/27/2008

Pubmed ID

18501806

DOI

10.1016/j.jamcollsurg.2007.11.023

Scopus ID

2-s2.0-43849099868 (requires institutional sign-in at Scopus site)   129 Citations

Abstract

BACKGROUND: We wanted to evaluate clinical and economic outcomes after thyroidectomy in patients 65 years of age and older, with special analyses of those aged 80 years and older, in the US.

STUDY DESIGN: This was a population-based study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2003-2004, a national administrative database of all patients undergoing thyroidectomy and their surgeon providers. Independent variables included patient demographic and clinical characteristics and surgeon descriptors, including case volume. Clinical and economic outcomes included mean total costs and length of stay (LOS), in-hospital mortality, discharge status, and complications.

RESULTS: There were 22,848 patients who underwent thyroidectomies, including 4,092 (18%) aged 65 to 79 years and 744 (3%) 80 years of age or older. On a population level, patient age is an independent predictor of clinical and economic outcomes. Average LOS for patients 80 years and older is 60% longer than for similar patients 65 to 79 years of age (2.9 versus 2.2 days; p < 0.001), complication rates are 34% higher (5.6% versus 2.1%; p < 0.001), and total costs are 28% greater ($7,084 versus $5,917; p < 0.001). High-volume surgeons have shorter LOS and fewer complications but perform fewer thyroidectomies for aging Americans; although they do nearly 29% of these procedures in patients younger than 65 years, they do just 15% of thyroidectomies in patients 80 years and older and 23% in patients 65 to 79 years.

CONCLUSIONS: On a population level, clinical and economic outcomes for patients 65 years and older undergoing thyroidectomies are considerably worse than for similar, younger patients. The majority of thyroidectomies in aging Americans is performed by low-volume surgeons. More data are needed about longterm outcomes, but increased referrals to high-volume surgeons for aging Americans are necessary.

Author List

Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Distribution
Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Hospital Costs
Hospital Mortality
Humans
Length of Stay
Male
Thyroid Diseases
Thyroidectomy
Treatment Outcome
United States