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A Nationwide Review of Pediatric Total Thyroidectomy and Lobectomy Outcomes
Zina Jawadi1, Laith Mukdad2, Josef Madrigal2
1UCLA David Geffen School of Medicine Los Angeles California USA.
Insights
Pediatric thyroid lobectomy (TL) is linked to fewer complications, shorter hospital stays, lower costs, and reduced readmissions compared to total thyroidectomy (TT). This finding aids in optimizing pediatric thyroid cancer treatment decisions.
Area of Science:
- Endocrinology
- Pediatric Surgery
- Oncology
Background:
- Pediatric thyroid cancer (PTC) differs significantly from adult forms.
- The American Thyroid Association updated guidelines in 2015.
- Thyroid lobectomy for PTC has seen increased utilization.
Purpose of the Study:
- To conduct the largest nationwide comparison of pediatric total thyroidectomy (TT) versus thyroid lobectomy (TL).
- To analyze differences in characteristics and clinical outcomes between TT and TL in pediatric patients.
- To inform decision-making in pediatric thyroid disease management.
Main Methods:
- Retrospective cross-sectional analysis of the Nationwide Readmissions Database (2010-2019).
- Included pediatric patients (<18 years) undergoing TT or TL.
- Compared complication rates, length of stay (LOS), costs, and 30-day readmission rates.
Main Results:
- 3793 patients analyzed; 72.4% TT, 27.6% TL.
- TT associated with significantly higher rates of hypocalcemia (25% vs 11%).
- TT showed increased LOS (2 vs 1 day), higher costs ($12,900 vs $9700), and higher readmission rates (2% vs 0%).
Conclusions:
- Thyroid lobectomy (TL) in pediatric patients is associated with better outcomes than total thyroidectomy (TT).
- TL demonstrates reduced postoperative hypocalcemia, shorter LOS, lower costs, and decreased readmission risk.
- Findings support informed clinical decision-making for pediatric thyroid surgery.
Objective:
Pediatric thyroid cancer (PTC) exhibits unique differences in pathophysiology, clinical presentation, and outcomes compared to adult thyroid cancer. In 2015, the American Thyroid Association released inaugural recommendations for pediatric thyroid nodules and cancer management. Significant increases in thyroid lobectomy for PTC have since been reported. This study represents the largest nationwide analysis comparing characteristics and clinical outcomes in pediatric total thyroidectomy (TT) and thyroid lobectomy (TL).
Methods:
A retrospective cross-sectional analysis of the Nationwide Readmissions Database (NRD) from 2010 to 2019 was performed. The study population included pediatric (< 18 years) patients undergoing TT and TL. Thyroidectomy procedures were classified using ICD-9-CM and ICD-10-PCS procedure codes, which do not distinguish between initial (primary) lobectomy and completion thyroidectomy. Due to coding limitations, the TL group includes both initial and completion lobectomies. Data were analyzed in September 2022. Primary outcomes included complication rates, hospitalization length of stay (LOS), costs, and 30-day readmission rates.
Results:
3793 patients were included. 72.4% underwent TT, and 27.6% had TL. Median age was 15; 78% were female. Surgical indications included thyroid cancer (43%), toxic thyroid disease (28%), benign disease (24%), and MEN 2A/B (4%). Risk of postoperative hypocalcemia was significantly increased in TT (25%) compared to TL (11%) (p < 0.001). LOS was significantly increased in TT (2 days) compared to TL (1) (p < 0.001). Median total costs were higher in TT ($12,900) than in TL ($9700) (p < 0.001). Thirty-day non-elective readmission rate was 2% for TT and 0% for TL (p < 0.001).
Conclusion:
This study represents the largest nationwide analysis comparing pediatric total thyroidectomy and lobectomy to date, revealing TL's association with reduced postoperative hypocalcemia, LOS, cost, and readmission risk. As pediatric thyroid management patterns continue to change, this study provides critical information to guide management and decision-making, improving patient outcomes.
Level Of Evidence:
III.
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