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Current trends and 30-day surgical outcomes for thyroglossal duct cyst excision in children
Jeffrey Cheng1, Reginald Lerebours2, Hui-Jie Lee2
1Pediatric Otolaryngology, Department of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Insights
Pediatric thyroglossal duct cyst surgery had a 4.4% adverse event rate, primarily unplanned reoperations and readmissions. Outpatient procedures were more common and safer than inpatient surgeries for children.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Thyroglossal Duct Cysts
Background:
- Thyroglossal duct cysts are congenital anomalies requiring surgical excision.
- Understanding surgical trends and outcomes is crucial for optimizing pediatric care.
Purpose of the Study:
- To identify current trends, adverse events, and clinical predictors in pediatric thyroglossal duct cyst surgery.
- To analyze outcomes based on inpatient versus outpatient settings.
Main Methods:
- Cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP® - pediatric) database (2012-2016).
- Identification of patients using CPT codes for thyroglossal duct cyst excision (60280, 60281).
Main Results:
- 1532 pediatric cases were analyzed; 1199 were outpatient and 333 were inpatient.
- The overall adverse event rate was 4.4%, with higher rates in inpatient cases (p=0.006).
- Most common adverse events included wound infections (2.6%), unplanned reoperations (2.2%), and readmissions (2.0%).
Conclusions:
- Unplanned reoperations and readmissions were the most frequent adverse events following pediatric thyroglossal duct cyst surgery.
- Outpatient surgery is prevalent and associated with lower adverse event rates compared to inpatient procedures.
- Children undergoing outpatient surgery were generally healthier, contributing to better outcomes.
Objective:
Identify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery.
Methods:
Cross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012-2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent.
Results:
1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008).
Conclusions:
The most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.
