全国儿童甲状腺全切除术和肺叶切除术结果综述

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-07-07 DOI:10.1002/lio2.70191

Zina Jawadi, Laith Mukdad, Josef Madrigal, Alisha West, Maie St. John

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引用次数: 0

摘要

目的与成人甲状腺癌相比，儿童甲状腺癌（PTC）在病理生理、临床表现和预后方面存在独特差异。2015年，美国甲状腺协会发布了儿童甲状腺结节和癌症管理的首份建议。此后有报道称PTC患者甲状腺小叶切除术显著增加。这项研究代表了全国范围内最大的比较儿科甲状腺全切除术（TT）和甲状腺叶切除术（TL）的特征和临床结果的分析。方法对2010 - 2019年全国再入院数据库（NRD）进行回顾性横断面分析。研究人群包括接受TT和TL的儿科（18岁）患者。甲状腺切除术的手术方式使用ICD-9-CM和ICD-10-PCS手术代码进行分类，该程序代码不区分初始（原发性）肺叶切除术和完全甲状腺切除术。由于编码的限制，TL组包括初始和完成脑叶切除术。数据分析于2022年9月进行。主要结局包括并发症发生率、住院时间（LOS）、费用和30天再入院率。结果共纳入3793例患者。72.4%接受了TT， 27.6%接受了TL。中位年龄15岁；78%是女性。手术指征包括甲状腺癌（43%）、中毒性甲状腺疾病（28%）、良性疾病（24%）和MEN 2A/B（4%）。术后低钙血症的风险在TT组（25%）明显高于TL组（11%）（p < 0.001）。与TL(1)相比，TT(2)组LOS显著增加（p < 0.001）。治疗组的总成本中位数（12,900美元）高于治疗组（9700美元）（p < 0.001）。30天非选择性再入院率TT为2%，TL为0% （p < 0.001）。本研究是迄今为止全国范围内最大规模的比较儿科甲状腺全切除术和肺叶切除术的分析，揭示了TL与降低术后低钙血症、LOS、成本和再入院风险的关系。随着儿童甲状腺管理模式的不断变化，本研究为指导管理和决策提供了重要信息，改善了患者的预后。证据水平

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A Nationwide Review of Pediatric Total Thyroidectomy and Lobectomy Outcomes

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A Nationwide Review of Pediatric Total Thyroidectomy and Lobectomy Outcomes

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.