A Nationwide Review of Pediatric Total Thyroidectomy and Lobectomy Outcomes.
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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.