A Population-Based Study of Outcomes from Thyroidectomy in Aging Americans: At What Cost?
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.
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A significant association is seen between increasing thyroidectomy volume and improved patient outcome; the association is robust and is more pronounced with an increasing number of thyroidectomies.
“A significant association is seen between increasing thyroidectomy volume and improved patient outcome; the association is robust and is more pronounced with an increasing number of thyroidectomies (198,199).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [198]
Improved patient outcome has been shown to be independently associated with high thyroidectomy surgeon volume; average complication rates, length of hospital stay, and cost are reduced when the operation is performed by a high-volume surgeon.
“Improved patient outcome has been shown to be independently associated with high thyroidectomy surgeon volume; specifically, average complication rates, length of hospital stay, and cost are reduced when the operation is performed by a surgeon who conducts many thyroidectomies.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [198]
High-volume thyroid surgeons tend to have better outcomes following lobectomy than low-volume surgeons, but the differences are not statistically significant.
“Highvolume thyroid surgeons tend to have better outcomes following lobectomy than low-volume surgeons, but the differences are not statistically significant (198).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [198]
Studies conducted at the population level have demonstrated significantly higher rates of postoperative complications, longer length of hospital stay, and higher costs among elderly patients undergoing thyroidectomy.
“Overall, however, studies conducted at the population level have demonstrated significantly higher rates of postoperative complications, longer length of hospital stay, and higher costs among elderly patients (198).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [198]
Surgeon volume of thyroidectomies is an independent predictor of patient clinical and economic outcomes following thyroid surgery.
“Robust data demonstrate that surgeon volume of thyroidectomies is an independent predictor of patient clinical and economic outcomes (i.e., in-hospital complications, length of stay, and total hospital charges) following thyroid surgery (198,199,293).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [198]
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References 38 · Cited by 159
- Authors
- Ann Sosa, J., Mehta, P. J., Wang, T. S., Boudourakis, L., & Roman, S. A.
- Affiliations
- Yale University (US)
- Medical College of Wisconsin (US)
- Corresponding author
- Roman, Sanziana A.
- Venue
- Journal of the American College of Surgeons
- Published
- 2008-06
- Volume
- 206
- Issue
- 6
- Pages
- 1097-1105
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W2020441165
- Cited by
- 159
- References
- 38
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 11 · 2021: 7 · 2020: 11 · 2019: 13 · 2018: 13 · 2017: 9 · 2016: 8 · 2015: 11 · 2014: 8 · 2013: 10 · 2012: 13
- FWCI
- 10.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- thyroidectomy, elderly patients, older adults, in-hospital mortality, postoperative complications, length of hospital stay, hospital costs, surgeon volume, high-volume surgeons, geriatric surgery, surgical outcomes
- MeSH terms
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Length of Stay, Male, Outcome and Process Assessment, Health Care, Thyroid Diseases, Thyroidectomy, United States, Treatment Outcome, Hospital Mortality, Outcome Assessment, Health Care, Age Distribution, Hospital Costs
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