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Patel AM, Shaari AL, Aftab OM, Lemdani MS, Choudhry HS, Filimonov A. Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:1910-1920. [PMID: 38566654 PMCID: PMC10982178 DOI: 10.1007/s12070-023-04444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS ≥ 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization. Level of Evidence: IV. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04444-3.
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Affiliation(s)
- Aman M. Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Ariana L. Shaari
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Owais M. Aftab
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Mehdi S. Lemdani
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Hassaam S. Choudhry
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Andrey Filimonov
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
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Grant RRC, Moroz BE, Nilubol C, Cahoon EK, Pfeiffer RM, Nilubol N. Parathyroidectomy and the Risk of Major Cerebrovascular and Cardiovascular Events in the Elderly. Ann Surg 2023; 278:1032-1037. [PMID: 37450696 PMCID: PMC10792119 DOI: 10.1097/sla.0000000000005999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE We aimed to determine the incidence of major cardiovascular and cerebrovascular events in elderly patients with primary hyperparathyroidism (pHPT) and the impact of parathyroidectomy. SUMMARY BACKGROUND DATA pHPT is underdiagnosed and undertreated in the United States. It is associated with increased cardiovascular disease risk, but its association with cerebrovascular disease risk is not well-established. It is also unknown if parathyroidectomy reduces these risks. METHODS The incidence of major cerebrovascular and cardiovascular events in 108,869 patients with pHPT diagnosed in the Medicare database between 2008 and 2018 and a matched comparison group of 1,088,690 Medicare subjects was prospectively evaluated. We estimated hazard ratios (HR) for the association of pHPT and parathyroidectomy for the risk of these outcomes from Cox proportional hazards models. Survival curves were calculated to obtain 5-year disease-free survival estimates. RESULTS For patients with pHPT, five-year disease-free survival was lower, and HRs were higher than the comparison group for any outcome (75.9% vs. 78.4; HR 1.11, 95% confidence interval [CI] 1.09-1.13), major cerebrovascular events (84.5% vs. 86.3%; HR 1.14, 95% CI 1.12-1.17), and major cardiovascular events (87.7% vs. 88.8%; HR 1.06, 95% CI 1.03-1.08). However, in patients who had parathyroidectomy, the risks of major cerebrovascular and cardiovascular events did not differ from the comparison cohort. The lower risk in patients who had parathyroidectomy was maintained in subgroup analyses. CONCLUSIONS Older patients with pHPT have an increased risk of major cerebrovascular and cardiovascular events compared with patients without the disease. Physicians treating older patients with primary hyperparathyroidism should consider parathyroidectomy.R.M.P. and N.N. contributed equally to the preparation of this manuscript.
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Affiliation(s)
- Robert R C Grant
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brian E Moroz
- Computing and Software Solutions for Science, LLC, Bethany Beach, DE
| | - Chanigan Nilubol
- Division of Nephrology and Hypertension, Department of Medicine, Medstar Georgetown University Medical Center, Washington, DC
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Rizk Y, Saad N, Arnaout W, Chalah MA, Farah S. Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management. J Clin Med 2023; 12:6321. [PMID: 37834965 PMCID: PMC10573864 DOI: 10.3390/jcm12196321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. METHODS Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013-2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. RESULTS The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. CONCLUSION PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.
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Affiliation(s)
- Youssef Rizk
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Nour Saad
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Wassim Arnaout
- Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon; (Y.R.); (N.S.); (W.A.)
| | - Moussa A. Chalah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), 75116 Paris, France
| | - Stephanie Farah
- Endocrinology, Diabetes and Metabolism, Private Practice, Haddade Street, Batroun P.O. Box 1400, Lebanon
- Division of Research, LAU Medical Center-Rizk Hospital, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
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Sutton W, Canner JK, Shank JB, Fingeret AL, Karzai S, Segev DL, Prescott JD, Mathur A. The impact of patient age on practice patterns and outcomes for primary hyperparathyroidism. Am J Surg 2022; 224:400-407. [DOI: 10.1016/j.amjsurg.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
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Mueller M, Ebrahimi F, Christ E, Nebiker CA, Schuetz P, Mueller B, Kutz A. Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism. Endocr Connect 2021; 10:1273-1282. [PMID: 34519277 PMCID: PMC8558907 DOI: 10.1530/ec-21-0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. METHODS Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. RESULTS We studied 2642 patients with a median (IQR) age of 62 (53-71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: odds ratio (OR): 0.51 (95% CI, 0.28 to 0.92); 65-74 years: OR: 0.72 (95% CI, 0.39 to 1.33); ≥75 years: OR: 1.03 (95% CI, 0.54 to 1.95), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR: 2.38 (95% CI, 1.57 to 3.60)). CONCLUSION ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.
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Affiliation(s)
- Marlena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Correspondence should be addressed to M Mueller:
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | | | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Faculty of Medicine, University Hospital Basel, Basel, Switzerland
- Correspondence should be addressed to M Mueller:
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
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Cipriani C, Bilezikian JP. Non-surgical management of primary hyperparathyroidism in the aging population. Maturitas 2020; 136:49-53. [PMID: 32386666 DOI: 10.1016/j.maturitas.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/24/2023]
Abstract
Primary hyperparathyroidism (PHPT) is commonly observed in the aging population, and the average age at diagnosis has increased in the last 20 years. Parathyroidectomy, the only definitive cure for PHPT, is indicated in symptomatic and asymptomatic older PHPT patients with skeletal and renal disease. It is as effective in older patients as it is in younger patients. Nevertheless, older patients may present with comorbidities and greater frailty, leading to the possibility of more complications, higher morbidity and mortality after surgery. This review focuses on the non-surgical clinical management of PHPT in elderly patients. We also summarize the most recent literature regarding the pharmacological management of PHPT to reduce serum calcium levels, to improve bone mineral density or to do both in the aging population.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - John P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA.
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Duskin-Bitan H, Nemirovsky N, Slutzky-Shraga I, Gorshtein A, Masri-Iraqi H, Robenshtok E, Diker-Cohen T, Singer J, Shimon I, Hirsch D, Tsvetov G. Hyperparathyroidism in patients over 75: Clinical characteristics and outcome. Is conservative treatment a safe alternative? Maturitas 2020; 135:47-52. [PMID: 32252964 DOI: 10.1016/j.maturitas.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE With the current aging of the world's population, primary hyperparathyroidism (PHPT) is increasingly detected in the elderly. Yet data on the presentation and outcome of PHPT in this group are scarce. The objective was to describe a cohort of patients aged 75 years or more with PHPT observed in our endocrine clinic. STUDY DESIGN A retrospective analysis of medical records in an endocrine clinic at a tertiary hospital. We evaluated 182 patients with PHPT, aged 75 years or more at their last follow-up, all diagnosed at age 65 or more. Laboratory data were compared at diagnosis and last follow-up. RESULTS Mean age at diagnosis was 73 ± 4 years, last follow-up was at 83 ± 4 years, and mean follow-up was 11.3 ± 5.5 years. Osteoporosis, fractures, and nephrolithiasis were diagnosed in 114(63 %), 84(46 %), and 43(24 %) patients, respectively. Overall, 150 patients had an indication for surgery; of them, the 29 who underwent parathyroidectomy were younger than the non-operated patients and had higher rates of hypercalciuria. During the follow-up of the 141 patients who did not undergo operation, serum and urinary calcium levels significantly had decreased, and vitamin D level had increased at last visit (10.4 ± 0.5 mg/dl, 161 ± 70 mg/24 h, 69 ± 17 nmol/l, p < 0.01 respectively) compared with levels at diagnosis (10.6 ± 0.2 mg/dl, 223 ± 95 mg/24 h, 53 ± 15 nmol/l, respectively, p = 0.001). Overall, 38 of the 182 patients (20 %) died during follow-up; these patients were significantly older at diagnosis (76 ± 5 vs. 72 ± 4 years) but there were no differences in laboratory variables. CONCLUSIONS While most patients had a formal indication for surgery, few underwent parathyroidectomy. Serum and urinary calcium significantly decreased during follow-up in patients who did not undergo surgery. Our data are reassuring and support at least the consideration of conservative treatment for these patients.
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Affiliation(s)
- Hadar Duskin-Bitan
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Ilana Slutzky-Shraga
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Gorshtein
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Masri-Iraqi
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robenshtok
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talia Diker-Cohen
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Medicine A, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joelle Singer
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dania Hirsch
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gloria Tsvetov
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Huang DKR, Chou FF, Chi SY, Chan YC, Huang SC. Surgical management of primary hyperparathyroidism: A single-center experience. Asian J Surg 2017; 41:377-383. [PMID: 28689731 DOI: 10.1016/j.asjsur.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/25/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) can occur at any age. This study aimed to compare the necessity, feasibility, safety, and outcomes of parathyroidectomy in the management of minor-symptomatic or asymptomatic PHPT patients according to age (young vs. old). METHODS We retrospectively reviewed the medical records of 146 consecutive patients who underwent surgery for PHPT from January 2005 to June 2016 in our institution. The patients ranged in age from 12 to 85 years. For the analysis, the included patients (n = 137) were separated into young (age <50 years; n = 31, 22.6%) and old (age ≥50 years; n = 106, 77.4%) patients. The biochemical characteristics (parathyroid hormone, calcium, and creatinine levels), T-score of bone densitometry, surgical reports, pathology reports, perioperative intensive care unit care, and 30-day mortality were reviewed. RESULTS The average medical treatment course after diagnosis tended to be longer in the old group (33.3 vs. 26.2 weeks, p = 0.62). During the medical treatment course, the old group had a higher risk of developing new symptoms or severe complications (5.6% vs. 3.2%, p = 0.05), and the older patients seemed to have a longer postoperative hospitalization (p = 0.17). However, there were no significant differences in the 30-day mortality, immediate complications, and follow-up duration. CONCLUSION In older patients, surgical treatment of PHPT is safe and feasible, with comparable outcomes to in younger patients, and helps prevent the development or progression of symptoms and complication. Hence, parathyroidectomy should be the recommended treatment and should be performed in PHPT patients as early as possible, regardless their age and initial symptoms.
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Affiliation(s)
- David Kwan-Ru Huang
- Division of Cardiothoracic and Vascular Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Fong-Fu Chou
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan.
| | - Shun-Yu Chi
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Yi-Chia Chan
- Division of General Surgery, Department of Surgery, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Shun-Chen Huang
- Department of Pathology, Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
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Calò PG, Medas F, Loi G, Pisano G, Sorrenti S, Erdas E, Nicolosi A. Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center. Aging Clin Exp Res 2017; 29:15-21. [PMID: 27837463 DOI: 10.1007/s40520-016-0666-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disease, and its incidence increases with age. AIMS Our aim was to retrospectively evaluate the impact of age on patient outcomes following parathyroidectomy for primary hyperparathyroidism. METHODS Two-hundred fifty-six consecutive patients undergoing parathyroidectomy with preoperative diagnosis of primary hyperparathyroidism were divided into three groups according to patient age: group A, ≤64 years; group B, 65-74 years; and group C, ≥75 years. RESULTS Thyroid disease was associated with the hyperparathyroidism in 44 patients (28.2%) in group A, 34 (44.7%) in B, and 10 (41.7%) in C (p < 0.01). Minimally invasive parathyroidectomy was performed in 104 patients (66.7%) in group A, 35 (46.1%) in B, and 8 (33.3%) in C (p < 0.01). Conversion to bilateral exploration was carried out in five cases in group A (4.6%), three in B (8.3%), and two in C (20%). Multiglandular disease was observed in six patients (3.8%) in group A, seven (9.2%) in B, and five (20.8%) in C (p = 0.012). Mean postoperative stay was similar between groups; no major complications and no cases of mortality occurred. DISCUSSION Multiglandular disease is more common in older patients than younger individuals, and minimally invasive approaches are less used in this patient group. Increased surgical risk and paucity of symptoms in these patients sometimes result in a delay in surgical treatment. CONCLUSIONS Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age.
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Affiliation(s)
- Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Giulia Loi
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Giuseppe Pisano
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Angelo Nicolosi
- Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Affiliation(s)
- Beatrice Wong
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Xiangbing Wang
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia. ANNALES D'ENDOCRINOLOGIE 2016; 77:600-605. [DOI: 10.1016/j.ando.2015.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022]
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12
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Oltmann SC, Rajaei MH, Sippel RS, Chen H, Schneider DF. Primary hyperparathyroidism across the ages: presentation and outcomes. J Surg Res 2014; 190:185-90. [PMID: 24801542 DOI: 10.1016/j.jss.2014.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a disease process traditionally thought to present during middle age, but can occur at any age. The purpose of this study was to compare PHPT patient characteristics based on patient age at the time of surgical referral. METHODS A retrospective review of a prospectively managed database of adult patients undergoing parathyroid surgery for PHPT was conducted. Patients with a negative family history, no previous parathyroid surgery, and ≥6-mo follow-up were included. Patients were grouped by age for comparison. RESULTS From 2001-2012, 1372 patients met inclusion criteria. Age groups were as follows: ≤50 y, 51-60 y, 61-70 y, and >70 y. Female predominance increased with age (P>0.01). Baseline serum parathyroid hormone levels were higher at the extremes of age (P<0.001). Young patients had the highest serum calcium (P<0.01), urinary calcium (P<0.001), and T-score (P<0.001) measures, and greater incidence of vitamin D deficiency (P=0.03). The use of local anesthesia increased with age, whereas use of outpatient parathyroidectomy decreased with age (both P<0.01). Rates of disease persistence (2.3%-2.9%, P=0.95) and recurrence (2.1%-3.3%, P=0.75) were low, and did not differ. CONCLUSIONS Patients at the extremes of age are referred with more elevated laboratory indices whereas those in the traditional age range have milder biochemical indices. This may result from differential surgical referral. Individuals with laboratory evidence of abnormal calcium and parathyroid hormone regulation should be evaluated for parathyroidectomy regardless of age because all ages can be successfully treated.
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Affiliation(s)
- Sarah C Oltmann
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Mohammad H Rajaei
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rebecca S Sippel
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Herbert Chen
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - David F Schneider
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Mekel M, Gilshtein H, Chapchay K, Bishara B, Krausz MM, Freund HR, Kluger Y, Eid A, Mazeh H. Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned? Ann Surg Oncol 2013; 21:1369-73. [DOI: 10.1245/s10434-013-3402-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Indexed: 11/18/2022]
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Webb SM, Puig-Domingo M, Villabona C, Muñoz-Torres M, Farrerons J, Badia X. Development of a new tool for assessing health-related quality of life in patients with primary hyperparathyroidism. Health Qual Life Outcomes 2013; 11:97. [PMID: 23777622 PMCID: PMC3710251 DOI: 10.1186/1477-7525-11-97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 05/27/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Several studies in recent years have evaluated Health Related Quality of Life (HRQoL) of patients with primary hyperparathyroidism (PHPT). No disease specific questionnaires are available to assess the impact of the disease. The aim of this research is to describe the development of a new disease specific Quality of Life (QoL) questionnaire for use specifically with PHPT patients. METHODS A conceptual model was developed describing the impact of the disease and its symptoms on QoL domains. A literature review was conducted to identify the most relevant domains. A focus group with experts was used to validate the domains; 24 patients were also interviewed to complement the information from the patient's perspective. A content analysis of the interviews was performed to identify items related with the impact of the disease, leading to PHPQoL-V.1 which was presented to a sample of 67 patients. Reliability was assessed by Cronbach's coefficient alpha and item-total score correlations. Validity was assessed by a factor analysis performed to determine the number of domains. Rasch analysis was carried out in order to refine the questionnaire items. RESULTS 259 items were extracted from the interviews that were subsequently reduced to 34 items. Cronbach's coefficient alpha was 0.92. The factor analysis extracted two domains (physical and emotional). After Rasch analysis the questionnaire PHPQoL-V.2 kept 16 items (9 physical and 7 emotional). The questionnaire was developed in a Spanish population and the final version was translated to English through translation and back-translation. CONCLUSION The first disease specific HRQoL questionnaire for PHPT patients (PHPQoL-16) has been developed. Validation studies designed to assess measurement properties of this tool are currently underway.
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Affiliation(s)
- Susan M Webb
- Department of Medicine/Endocrinology, Hospital Sant Pau, Pare Claret 167, Barcelona, 08025, Spain
- Centro de Investigación Biomédica de Enfermedades Raras (CIBER_ER Unit 747), Instituto de Salud Carlos III Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Puig-Domingo
- Service of Endocrinology and Nutrition, Hospital Universitary Germans Trias i Pujol Crtra, Canyet, Badalona, 08916, Spain
| | - Carles Villabona
- Service of Endocrinology and Nutrition, Hospital Universitary Bellvitge, C/ de la Feixa Llarga, L'Hospitalet de Llobregat, 08907, Spain
| | - Manuel Muñoz-Torres
- Service of Endocrinology and Nutrition, Hospital Universitary San Cecilio, C/ Doctor Oloriz, 16, Granada, 18012, Spain
| | - Jordi Farrerons
- Department of Medicine/Internal Medicine, Unidad de Metabolismo Minero-cálcico. Hospital Sant Pau, Pare Claret, 167, Barcelona, 08025, Spain
| | - Xavier Badia
- IMS Health, C/ Dr. Ferrán, 25-27, 2nd floor, Barcelona, 08034, Spain
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Thomas DC, Roman SA, Sosa JA. Parathyroidectomy in the Elderly: Analysis of 7313 Patients. J Surg Res 2011; 170:240-6. [DOI: 10.1016/j.jss.2011.03.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/13/2011] [Accepted: 03/03/2011] [Indexed: 11/15/2022]
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Zenilman ME, Chow WB, Ko CY, Ibrahim AM, Makary MA, Lagoo-Deenadayalan S, Dardik A, Boyd CA, Riall TS, Sosa JA, Tummel E, Gould LJ, Segev DL, Berger JC. New Developments in Geriatric Surgery. Curr Probl Surg 2011; 48:670-754. [DOI: 10.1067/j.cpsurg.2011.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
The prevalence of primary hyperparathyroidism (PHPT) will increase with the growth of the elderly population. Elderly patients primarily present with nonclassic symptoms of PHPT that can sometimes be missed in favor of other diagnoses. Several recent studies demonstrate the safety and efficacy of outpatient, minimally invasive parathyroidectomy in elderly patients with PHPT, the majority of them reporting increased fracture-free survival and symptomatic relief postoperatively and thus experiencing improved quality of life. Introduction. The prevalence of primary hyperparathyroidism (PHPT) is expected to increase in developed nations as the aged population grows. This review discusses issues related to PHPT in the elderly population with a focus on differences in disease presentation, medical and surgical management, and outcomes. Methods. Literature review of English-language studies of PHPT or parathyroidectomy (PTx) in the elderly was performed. Surgical literature reviewed included original clinical studies published after 1990. Priority was given to studies with >30 patients where institutional practice and outcomes have not changed significantly over time. Results. Elderly patients primarily present with nonclassic symptoms of PHPT that can sometimes be missed in favor of other diagnoses. They have equivalent surgical outcomes, including morbidity, mortality, and cure rates, compared with younger patients, although their length of hospital stay is significantly longer. Several recent studies demonstrate the safety and efficacy of outpatient, minimally invasive parathyroidectomy in an elderly population. Patients are referred for PTx less frequently with each advancing decade, although surgical referral patterns have increased over time in centers that offer minimally invasive parathyroidectomy. Elderly patients experience increased fracture-free survival after PTx. The majority of elderly patients report symptomatic relief postoperatively. Conclusion. PTx can offer elderly patients with PHPT improved quality of life. PTx is safe and effective in elderly patients, and advanced age alone should not deter surgical referral.
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Affiliation(s)
- Lilah F. Morris
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juliette Zelada
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bian Wu
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Theodore J. Hahn
- VA Greater Los Angeles Geriatric Research, Education and Clinical Center and Division of Geriatric Medicine, Los Angeles, California, USA
| | - Michael W. Yeh
- Endocrine Surgical Unit, Department of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Wu B, Haigh PI, Hwang R, Ituarte PHG, Liu ILA, Hahn TJ, Yeh MW. Underutilization of parathyroidectomy in elderly patients with primary hyperparathyroidism. J Clin Endocrinol Metab 2010; 95:4324-30. [PMID: 20610600 PMCID: PMC2936062 DOI: 10.1210/jc.2009-2819] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) disproportionately affects older patients, who may face higher thresholds for surgical intervention compared to young patients. OBJECTIVE The aim was to examine for differences in the utilization of parathyroidectomy attributable to age. DESIGN We conducted a retrospective cohort study. PARTICIPANTS Patients with biochemically diagnosed PHPT during the years 1995-2008 were identified within an integrated health care delivery system in Southern California encompassing approximately 3 million individuals. MAIN OUTCOME MEASURES The outcome measures were parathyroidectomy (PTx) and time interval to surgery. RESULTS We found 3388 patients with PHPT, 964 (28%) of whom underwent PTx. Patients aged 60+ yr comprised 60% of the study cohort. The likelihood of PTx decreased linearly among patients aged 60+ when compared to patients aged 50-59, an effect that persisted in multivariate analysis: odds ratio 0.68 for ages 60-69 (P < 0.05); 0.41 for ages 70-79 (P < 0.0001), and 0.11 for age 80+ (P < 0.0001). The PTx rate for patients aged 70+ was 14%. Among patients meeting 2002 consensus criteria for surgical treatment, 45% of those aged 60-69 and 24% of those aged 70+ underwent PTx. A Cox proportional hazards model showed that patients aged 60+ experienced significantly longer delays from diagnosis to surgery compared to young patients (P < 0.0001). CONCLUSIONS PHPT is undertreated in the elderly. We observed a progressive age-related decline in PTx rate that renders patients aged 70+ unlikely to have definitive treatment, irrespective of comorbidity and eligibility for surgery.
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Affiliation(s)
- Bian Wu
- Endocrine Surgical Unit, Department of Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095, USA
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Abstract
Parathyroidectomy is curative in primary hyperparathyroidism, but elderly patients are often denied this treatment owing to concerns over operative risks and doubts over efficacy of the intervention in improving symptoms. This view is changing, however, as evidence accumulates of the efficacy and safety of the procedure in the aged.
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