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Chandran M, Bilezikian JP, Salleh NM, Ying H, Lau J, Lee J, deJong MC, Chan Maung A, Parameswaran R. Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific. A cohort study. Osteoporos Sarcopenia 2022; 8:11-16. [PMID: 35415277 PMCID: PMC8987324 DOI: 10.1016/j.afos.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives We sought to assess the incidence of hungry bone syndrome (HBS) following parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) in a cohort of multi-ethnic patients from a developed country in the Asia Pacific. Methods One hundred and sixty-four patients who underwent PTX for PHPT between 2012 and 2019 at the 2 largest public hospitals in Singapore were identified. HBS was defined as serum albumin-adjusted calcium ≤ 2.1 mmol/L with normal or raised serum intact parathyroid hormone (iPTH) levels, manifesting on or after the 3rd day, or persisting for more than 3 days post-operatively. Results Chinese constituted 73.8%, Malays 12.2%, Indians 9.8%, and other races 4.3%. HBS developed in 4 patients (2.4%) (95% CI, 0.8%–6.5%). HBS patients had significantly longer in-hospital stays; 20 days [IQR:15–22] vs 2 days [IQR:1–3]; P < 0.001in those who did not develop HBS. There was no difference in the incidence of HBS stratifying for age, sex, vitamin D status, or use of preoperative anti-resorptive medication use. For every 10 unit increase in iPTH and alkaline phosphatase (ALP) levels, the risk of HBS increased by 14% and 11%; RR (95% CI), 1.14 (1.05–1.21) and 1.11 (1.03–1.18), respectively. Conclusions The low incidence of HBS in multi-ethnic patients undergoing PTX by multiple surgeons for PHPT at the 2 largest public hospitals that see the most such patients in Singapore, a developed country, is consistent with the asymptomatic/milder form of presentation of PHPT in the developed world.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Complicated Metabolic Bone Disorders Unit, Department of Endocrinology, Singapore General Hospital, Singapore
- Corresponding author. Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, 169856, Singapore.
| | - John P. Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Hao Ying
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | - Joel Lau
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - James Lee
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Mechteld C. deJong
- Department of Endocrine Surgery, National University Hospital, Singapore
| | - Aye Chan Maung
- Department of Endocrinology, Singapore General Hospital, Singapore
- Department of Endocrinology, Ealing Hospital, London North West Healthcare NHS Trust, United Kingdom
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Stefanova D, Ullmann TM, Limberg J, Moore M, Beninato T, Zarnegar R, Fahey TJ, Finnerty BM. Risk Factors for Prolonged Length of Stay and Readmission After Parathyroidectomy for Renal Secondary Hyperparathyroidism. World J Surg 2020; 44:3751-3760. [PMID: 32737558 DOI: 10.1007/s00268-020-05711-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Population-based analyses of 30-day outcomes after parathyroidectomy for renal secondary hyperparathyroidism are limited. We sought to identify risk factors associated with prolonged length of stay (LOS) and readmission in this patient population. METHODS Patients with secondary hyperparathyroidism who underwent parathyroidectomy were reviewed in the ACS-NSQIP database (2011-2016). Patients were identified by ICD codes specific to secondary hyperparathyroidism of renal origin and the ACS-NSQIP variable for current preoperative dialysis. Multivariable logistic regression was used to identify independent factors associated with prolonged LOS and 30-day readmission after parathyroidectomy. RESULTS The cohort included 1846 patients with secondary hyperparathyroidism on dialysis who underwent parathyroidectomy. There were 416 (22.5%) patients classified under the prolonged LOS group. On multivariable analysis, factors associated with prolonged LOS included elevated preoperative alkaline phosphatase [OR 3.13 (95%-CI 2.09-4.70), p < 0.001], decreased preoperative hematocrit [OR 1.83 (95%-CI 1.25-2.68), p = 0.002], unplanned reoperation (OR 5.02 [95%-CI 2.22-11.3], p < 0.001) and any postoperative complication [OR 6.12 (95%-CI 3.31-11.3), p < 0.001]. The overall 30-day readmission rate was 15.0%. Hypocalcemia and hungry bone syndrome accounted for 47.0% (n = 93/198) of readmissions. On multivariable analysis, patients with a history of hypertension and those undergoing unplanned reoperation were at risk of readmission [2.16 (95%-CI 1.21-3.87), p = 0.009, and 2.40 (95%-CI 1.15-5.02), p = 0.020, respectively], whereas reoperative parathyroidectomy was inversely associated with readmission (OR 0.24, 95%-CI 0.07-0.80, p = 0.021). CONCLUSION In patients undergoing parathyroidectomy for renal secondary hyperparathyroidism, several readily available preoperative biochemical markers, including those of increased bone turnover and anemia, are associated with prolonged postoperative LOS. Unplanned reoperation was predictive of both increased LOS and readmission.
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Affiliation(s)
- Dessislava Stefanova
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Timothy M Ullmann
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Jessica Limberg
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Maureen Moore
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Toni Beninato
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th Street, Suite F-838, New York, NY, 10065, USA.
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