CHICAGO — Octogenarians undergoing thyroid surgery experience a markedly increased rate of serious perioperative complications, compared with younger patients, according to Dr. Michal Mekel.
Dr. Mekel of Massachusetts General Hospital in Boston, presented a retrospective study involving 90 consecutive patients over age 80 years and 242 randomly selected 18- to 79-year-olds, all of whom underwent thyroid surgery at the hospital during the same recent period. Eighty percent of the octogenarians were women, Dr. Mekel reported at the annual meeting of the American Thyroid Association.
The overall 30-day complication rate was 23.3% in octogenarians and 9.1% in controls. Moreover, most affected octogenarians had multiple complications. However, no deaths occurred in either group. Mean length of stay was 1.67 days in patients over age 80 years, compared with 1.23 days in the younger group.
The most frequent complications in patients over age 80 years were cardiovascular, with 6.7% of octogenarians being affected. Pulmonary complications, occurring in 3.3%, were next most common.
Complications experienced only by the octogenarians included atrial fibrillation, other arrhythmias, heart failure, pneumonia, ischemic colitis, tracheostomy, urosepsis, blood transfusion, reintubation, and sternotomy-related wound infection secondary to resection of a large substernal goiter.
In a multivariate analysis, comorbid respiratory conditions proved to be an independent risk factor for perioperative complications in patients over age 80 years, conferring a 9.9-fold increased risk. Female gender was associated with a 3.3-fold increased risk of perioperative complications in the elderly.
Interestingly, advanced age was not an independent risk factor for serious complications. This finding underscores the point that while careful selection of elderly candidates for thyroid surgery is warranted, advanced biologic age is not a contraindication to surgery, Dr. Mekel emphasized.