TY - JOUR
T1 - Morbidity in parathyroid surgery for renal disease is under reported
T2 - A comparison of outcomes with primary hyperparathyroidism
AU - Nastos, Konstantinos
AU - Constantinides, V.
AU - Mizamtsidi, M.
AU - Duncan, N.
AU - Tolley, N.
AU - Palazzo, F.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - INTRODUCTION Parathyroidectomy is considered to be a safe procedure with low morbidity. However, while this is true for primary hyperparathyroidism, whether it applies to tertiary disease is not so well documented. The aim of this study was to assess the morbidity of surgery for tertiary hyperparathyroidism compared with primary disease and to establish whether there are predictive factors for poor outcomes. METHODS Data for patients subjected to parathyroidectomy during the period 2007-2015 were retrospectively analysed from a prospectively collected database. Patient age, sex, American Society of Anesthesiologists (ASA) score, renal status, extent of operation and indications for surgery were examined. The complication and mortality rate were compared and independent predictors of outcome were examined. RESULTS A total of 1079 patients were scheduled for a parathyroidectomy during the study period of whom 158 for renal related hyperparathyroidism (renal group) and 921 for primary disease (non-renal group). There was a significantly higher complication rate in the renal parathyroid group, including a higher mortality (1.3% vs 0.1%, P = 0.011), overall complication rate (7.0% vs 2.3%, P = 0.001), surgery related complication rate (4.4% vs 1.7%, P = 0.03) and systemic complication rate (2.5% vs 0.4%, P = 0.005). In patients with ASA score ≤ 2 reoperative surgery (OR 9.25, 95% confidence interval, CI 1.41-60.75), male sex (OR 4.12, 95% CI 1.46-11.63) and renal impairment were (OR 5.86, 95% CI 1.65-20.78) were predictors of worse outcomes. In patients with ASA score ≥3 renal impairment, in addition to other variables, were not predictors of complications. CONCLUSIONS Parathyroidectomy in renal-related disease is associated with a significantly higher risk of morbidity and mortality compared with primary hyperparathyroidism.
AB - INTRODUCTION Parathyroidectomy is considered to be a safe procedure with low morbidity. However, while this is true for primary hyperparathyroidism, whether it applies to tertiary disease is not so well documented. The aim of this study was to assess the morbidity of surgery for tertiary hyperparathyroidism compared with primary disease and to establish whether there are predictive factors for poor outcomes. METHODS Data for patients subjected to parathyroidectomy during the period 2007-2015 were retrospectively analysed from a prospectively collected database. Patient age, sex, American Society of Anesthesiologists (ASA) score, renal status, extent of operation and indications for surgery were examined. The complication and mortality rate were compared and independent predictors of outcome were examined. RESULTS A total of 1079 patients were scheduled for a parathyroidectomy during the study period of whom 158 for renal related hyperparathyroidism (renal group) and 921 for primary disease (non-renal group). There was a significantly higher complication rate in the renal parathyroid group, including a higher mortality (1.3% vs 0.1%, P = 0.011), overall complication rate (7.0% vs 2.3%, P = 0.001), surgery related complication rate (4.4% vs 1.7%, P = 0.03) and systemic complication rate (2.5% vs 0.4%, P = 0.005). In patients with ASA score ≤ 2 reoperative surgery (OR 9.25, 95% confidence interval, CI 1.41-60.75), male sex (OR 4.12, 95% CI 1.46-11.63) and renal impairment were (OR 5.86, 95% CI 1.65-20.78) were predictors of worse outcomes. In patients with ASA score ≥3 renal impairment, in addition to other variables, were not predictors of complications. CONCLUSIONS Parathyroidectomy in renal-related disease is associated with a significantly higher risk of morbidity and mortality compared with primary hyperparathyroidism.
KW - Morbidity
KW - Parathyroid surgery
KW - Primary hyperparathyroidism
KW - Renal
KW - Secondary hyperparathyroidism
UR - http://www.scopus.com/inward/record.url?scp=85049423515&partnerID=8YFLogxK
U2 - 10.1308/rcsann.2018.0032
DO - 10.1308/rcsann.2018.0032
M3 - Article
C2 - 29962299
AN - SCOPUS:85049423515
SN - 0035-8843
VL - 100
SP - 436
EP - 442
JO - Annals of the Royal College of Surgeons of England
JF - Annals of the Royal College of Surgeons of England
IS - 6
ER -