Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes.

Abstract

BACKGROUND\nTotal thyroidectomy is more common than lobectomy for low-risk papillary thyroid cancer, despite equipoise in survival. Because postoperative morbidity increases with age, we aimed to investigate how the extent of thyroidectomy affects short-term outcomes among older patients.\n\n\nMETHODS\nUsing the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients aged ≥66 years who were treated between 1996 and 2011 for papillary thyroid cancer with tumors ≤2 cm in diameter. We used multivariable logistic regression to evaluate the effect of extent of surgery on complications, emergency-department visits, and unplanned readmissions.\n\n\nRESULTS\nAmong 3,341 selected patients, 77.3% were female, mean age was 72.9 years, and tumors averaged 0.8 cm in diameter. A total of 67.6% of patients underwent total thyroidectomy, and 32.4% underwent lobectomy. Total thyroidectomy was associated with complications (odds ratio\xa0= 1.99) and readmissions (odds ratio\xa0= 1.59; both P < 0.01). Complications were higher in female patients (odds ratio\xa0= 1.34), black patients (versus white patients, odds ratio\xa0= 1.65), and those with ≥2 comorbidities (vs 0, odds ratio\xa0= 1.43; all P < 0.01). Black patients and those with ≥2 comorbidities had more emergency-department visits (odds ratio\xa0= 1.50 and 1.92, respectively) and readmissions (odds ratio\xa0= 2.19 and 2.29, respectively; all P < 0.01).\n\n\nCONCLUSION\nTotal thyroidectomy for older adults with low-risk papillary thyroid cancer may lead to potentially avoidable complications and readmissions, particularly for black and female patients. In many cases, lobectomy may be a safer and less costly alternative.