Thyroid surgery in the geriatric patient.

BACKGROUND

Although age itself is no contraindication for major surgical procedures, few patients 75 years and older undergo thyroid surgery.

HYPOTHESIS

Thyroid surgery in the geriatric patient can be performed with low morbidity and mortality.

DESIGN

Retrospective analysis of prospectively documented data.

SETTING

University hospital referral center.

PATIENTS

We included 738 patients undergoing thyroid surgery within 5 years, of whom 55 (7.5%) were 75 years or older (group 1) (mean +/- SD age, 79.9 +/- 4.1 years).

MAIN OUTCOME MEASURES

Indication for surgery, surgical strategy, morbidity, and mortality were analyzed and compared with those in younger patients (<75 years; group 2).

RESULTS

Malignancy was suspected or verified in 29 patients (52.7%) in group 1; 21 (38.2%) had mechanical symptoms due to large bilateral nodular goiters; and 5 (9.1%) presented with benign nodular goiter. The main indication in group 2 (n = 683) was benign nodular goiter in 455 (66.6%); 142 patients (20.8%) presented with suspected malignancy and 21 (3.1%) with mechanical symptoms (P<.001). Most patients underwent total thyroidectomy, hemithyroidectomy, or near-total thyroidectomy (n = 50 [90.9%; group 1] vs n = 597 [87.4%; group 2]; P =.53). Frequency of malignancy was higher in group 1 ([n = 20 [36.4%] vs n = 179 [26.2%]; P =.17). Morbidity of thyroid surgery was comparable in both groups. One (2.3%) of 44 patients in group 1 had permanent hypoparathyroidism, compared with 10 (2.0%) of 502 in group 2 (P =.61); permanent recurrent laryngeal nerve paralysis occurred in 1 (1.05%) of 95 nerves at risk in group 1 compared with 3 (0.26%) of 1172 nerves at risk in group 2 (P =.22). There was no perioperative mortality in either group.

CONCLUSIONS

Thyroid surgery in patients 75 years or older can be performed with low morbidity. The guarantees for success include an individual risk-and-benefit analysis and careful preoperative preparation.