title: What is the prevalence of a "nontherapeutic" thymectomy?
abstract: BACKGROUND
  Thymectomy is often performed on the basis of computed tomography scan findings that are suspicious for thymoma. However, the final diagnosis may be a condition such as thymic hyperplasia or lymphoma for which thymectomy is not therapeutic. The present analysis was undertaken to determine the prevalence of a "nontherapeutic" thymectomy.
  
  
  METHODS
  The Nationwide Inpatient Sample from 2000 through 2009 was queried to identify patients who underwent a thymectomy. Only adult patients who underwent a total thymectomy without other associated procedures were analyzed. Patients with a diagnosis of myasthenia were excluded. A nontherapeutic thymectomy was defined as a patient who underwent thymectomy with an International Classification of Diseases, Ninth Revision diagnosis code of lymphoma, thymic hyperplasia, thymic cyst, or other benign diseases of the thymus.
  
  
  RESULTS
  A total of 1,306 patients were identified. Overall, 72.2% (n = 943) of thymectomies were therapeutic and 27.8% (n = 363) were nontherapeutic. The most common diagnosis in the nontherapeutic group was thymic hyperplasia (n = 174). Mortality (0.32% versus 0%; p = 0.083) and overall complication rates (25% versus 17%; p < 0.001) were higher in the therapeutic group. Patients in the nontherapeutic group were younger (median age, 41 versus 56 years; p < 0.001) and more likely to undergo a video-assisted thoracoscopic surgery thymectomy (28% versus 19%; p = 0.085).
  
  
  CONCLUSIONS
  In this study, 27.8% of thymectomies were nontherapeutic, and most patients underwent an open approach. The most common benign diagnosis was thymic hyperplasia, a condition for which magnetic resonance imaging has a high predictive value. Consequently, further studies are warranted to determine the optimal evaluation of patients undergoing thymectomy for presumed thymoma.
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: mkent@bidmc.harvard.edu.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kent
authors.affiliation: Department of Economics, Harvard University, Cambridge, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wang
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sidhu P
authors.initials: SP
authors.lastname: Gangadharan
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Whyte
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D013945:Thymoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013952:Thymus Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: 13