Sažetak
Uvod/Cilj. Incidenca nodularnih bolesti štitaste žlezde značajno raste sa starenjem, kao i incidenca i agresivnost karcinoma štitaste žlezde. Cilj rada bio je da se utvrdi da li je operacija štitaste žlezde bezbedna kod starijih bolesnika u okviru koncepta kratkotrajnog postoperativnog boravka u bolnici. Metode. U studiji retrospektivnog tipa, analizirane su istorije bolesti svih operisanih bolesnika starijih od 65 godina kojimah je urađena totalna tireoidektomija (TT) ili hemitireoidektomija (HT) u periodu od januara 2012. do decembra 2018. godine. U navedenom periodu ukupno je operisano 976 bolesnika zbog bolesti štitaste žlezde, od kojih je 247 gerijatrijskih bolesnika ispunilo kriterijume da budu uključeni u studiju. Bolesnici kod kojih je bila rađena reoperacija štitaste žlezde, kao i bolesnici kod kojih je istovremeno bila urađena tireoidektomija i disekcija limfnih čvorova vrata, bili su isključeni iz studije. Gerijatrijski bolesnici bili su podeljeni u dve grupe – u prvoj grupi bili su bolesnici kod kojih je izvršena HT (33 bolesnika) a u drugoj su bili bolesnici kod kojih je izvršena TT (214 bolesnika). Svaka od ove dve gerijatrijske grupe, HT i TT, imala je po dve uparene kontrolne grupe. Prvu (I) kontrolnu grupu činili su mlađi bolesnici, od 20–44 godina, a drugu (II) kontrolnu grupu činili su bolesnici srednjih godina, od 45–64 godina. Rezultati. Sve tri grupe kod kojih je bila izvršena TT – gerijatrijska grupa i I i II kontrolna grupa, imale su po 214 bolesnika i svaka od tri grupe kod kojih je bila urađena HT imala je po 33 bolesnika. Kod bolesnika iz sve tri grupe kod kojih je bila izvršena HT, prosečan boravak u bolnici bio je 24 časa, dok je u gerijatrijskoj grupi bolesnika kojima je bila urađena TT, 150 (70,1%) od 214 bolesnika provelo 24 sata u bolnici. U gerijatrijskoj populaciji dolazilo je češće do pojave otoka u predelu vrata i povećane drenaže u odnosu na obe kontrolne grupe, pa je samim tim i postojala potreba za dužom hospitalizacijom. Poređenjem godina starosti, pokazano je da ispitanici sa svakom kasnijom godinom intervencije imaju za 22% manje šanse za nastanak komplikacija, kao i da kod benignih bolesti štitaste žlezde postoje manje šanse za nastanak komplikacija u odnosu na maligne bolesti. Zaključak. Prema rezultatima dobijenim u ovoj studiji, TT se može bezbedno sprovesti u okviru koncepta kratkog boravka u bolnici kod bolesnika mlađih od 65 godina, dok se kod starijih bolesnika dani hospitalizacije mogu produžiti zbog češćih hirurških i nehirurških komplikacija. Kod HT, kratkotrajni postoperativni boravak u bolnici je bezbedan za sve starosne grupe.
Ključne reči
hospitalizacija, dužina
hirurgija, mala
postoperativne komplikacije
faktori rizika
tireoidektomija
tireoidna žlezda
Reference
1. Lechner MG, Hershman JM. Thyroid Nodules and Cancer in the Elderly. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al, editors. Endotext [Internet]. South Dartmouth (MA): MD Text. com, Inc; 2000.
2. Gervasi R, Orlando G, Lerose MA, Amato B, Docimo G, Zeppa P, et al. Thyroid surgery in geriatric patients: a literature review. BMC Surg 2012; 12(Suppl 1): S16.
3. Guarino S, Di Cosimo C, Chiesa C, Metere A, Di Bella V, Filippini A, et al. Perioperative care in elderly patients undergoing thyroid surgery. Int J Surg 2014; 12(Suppl 2): S78‒S81.
4. Alderson P. European charter of children's rights. Bull Med Ethics 1993; 92: 13‒5.
5. Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003; 47(10): 1204‒10.
6. Canonico S, Pellino G, Pameggiani D, Sciaudone G, Candilio G, De Fatico GS, et al. Thyroid surgery in the elderly: a comparative experience of 400 patients from an Italian university hospital. Int Surg 2014; 99(5): 523‒7.
7. Doran HE, England J, Palazzo F. British Association of Endocrine and Thyroid Surgeons. Questionable safety of thyroid surgery with same day discharge. Ann R Coll Surg Engl 2012; 94(8): 543‒7.
8. Inversini D, Morlacchi A, Melita G, Del Ferraro S, Boeri C, Portinari M, et al. Thyroidectomy in elderly patients aged ≥70 years. Gland Surg 2017; 6(5): 587‒90.
9. Ng SH, Wong KP, Lang BH. Thyroid surgery for elderly patients: are they at increased operative risks? J Thyroid Res 2012; 2012: 946276.
10. Toftgaard C, Parmentier G. International terminology in ambulatory surgery and its worldwide practice. In: Lemos P, Jarrett PEM, Philip B, editors. Day surgery – development and practice. London: International Association for Ambulatory Surgery; 2006: p. 35‒60.
11. Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, et al. Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery. Anaesthesia 2019; 74(6): 778‒92.
12. Lang BH, Yih PC, Lo CY. A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe? World J Surg 2012; 36(10): 2497‒502.
13. Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001; 130(6): 914‒20.
14. Abbas G, Dubner S, Heller KS. Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck 2001; 23(7): 544‒6.
15. Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 2008; 195(3): 339‒43; discussion 343.
16. Leyre P, Desurmont T, Lacoste L, Odasso C, Bouche G, Beaulieu A, et al. Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery? Langenbecks Arch Surg 2008; 393(5): 733‒7.
17. Shaha AR, Jaffe BM. Practical management of post-thyroidectomy hematoma. J Surg Oncol 1994; 57(4): 235‒8.
18. Godballe C, Madsen AR, Pedersen HB, Sørensen CH, Pedersen U, Frisch T, et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol 2009; 266(12): 1945‒52.
19. Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 2000; 24(8): 971‒5.
20. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008; 393(5): 667‒73.
21. Steward DL. The pros and cons of outpatient thyroidectomy. JAMA Otolaryngol Head Neck Surg 2014; 140(11): 1074‒6.
22. Calò PG, Erdas E, Medas F, Pisano G, Barbarossa M, Pomata M, et al. Late Bleeding after Total Thyroidectomy: Report of Two Cases occurring 13 Days after Operation. Clin Med Insights Case Rep 2013; 6: 165‒70.
23. Campbell MJ, McCoy KL, Shen WT, Carty SE, Lubitz CC, Moalem J, et al. A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery 2013; 154(6): 1283‒89; discussion 1289‒91.
24. Dralle H, Sekulla C, Lorenz K, Grond S, Irmscher B. Ambulatory and brief inpatient thyroid gland and parathyroid gland surgery. Chirurg 2004; 75(2): 131‒43. (German)
25. Zhou HY, He JC, McHenry CR. Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res 2016; 205(1): 70‒5.
26. Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998; 164(7): 501‒6.
27. Noordzij JP, Lee SL, Bernet VJ, Payne RJ, Cohen SM, McLeod IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg 2007; 205(6): 748‒54.
28. Cernea CR, Brandão LG, Hojaij FC, De Carlucci D Jr, Brandão J, Cavalheiro B, et al. Negative and positive predictive values of nerve monitoring in thyroidectomy. Head Neck 2012; 34(2): 175‒9.
29. Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 2004; 136(6): 1107‒15.
30. Schwartz N, Shpitzer T, Feinmesser R, Robenshtok E, Bachar G. Thyroid surgery in the elderly. Gerontology 2013; 59(5): 401‒7.
31. Tartaglia F, Russo G, Sgueglia M, Blasi S, Tortorelli G, Tromba L, et al. Total Thyroidectomy in geriatric patients: a retrospective study. Int J Surg 2014; 12(Suppl 2): S33‒S36.
32. Seybt MW, Khichi S, Terris DJ. Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg 2009; 135(10): 1041‒4.
33. Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S. Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 2009; 146(5): 913‒21.
34. Passler C, Avanessian R, Kaczirek K, Prager G, Scheuba C, Niederle B. Thyroid surgery in the geriatric patient. Arch Surg 2002; 137(11): 1243‒8.
35. Gourin CG, Tufano RP, Forastiere AA, Koch WM, Pawlik TM, Bristow RE. Volume-based trends in thyroid surgery. Arch Otolaryngol Head Neck Surg 2010; 136(12): 1191‒8.
36. Meltzer C, Klau M, Gurushanthaiah D, Titan H, Meng D, Radler L, et al. Risk of Complications after Thyroidectomy and Parathyroidectomy: A Case Series with Planned Chart Review. Otolaryngol Head Neck Surg 2016; 155(3): 391‒401.
37. Caulley L, Johnson-Obaseki S, Luo L, Javidnia H. Risk factors for postoperative complications in Total Thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Medicine (Baltimore) 2017; 96(5): e5752.
38. Butler D, Oltmann S. Is Outpatient Thyroid Surgery for Everyone? Clin Med Insights Ear Nose Throat 2017; 10: 1179550617724428.
39. Ayala MA, Yencha MW. Outpatient Thyroid Surgery in a Low-Surgical Volume Hospital. World J Surg 2015; 39(9): 2253‒8.