Effect of Hypoalbuminemia in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

Abstract

Objectives Treatment for primary hyperparathyroidism is parathyroidectomy. This study identifies the association between hypoalbuminemia (HA) and outcomes in patients undergoing parathyroidectomy for primary hyperparathyroidism. Methods This retrospective cohort analysis utilized the 2006–2015 National Surgical Quality Improvement Program database. Current Procedure Terminology codes were used to identify patients undergoing parathyroidectomy for primary hyperparathyroidism. Prolonged length of stay (LOS) was defined as a duration of 2 days or greater. Demographics and comorbidities were compared between HA (serum albumin <3.5 g/dL) and non‐HA cohorts using chi‐square analysis. The independent effect of HA on adverse outcomes was analyzed using binary logistic regression. Results A total of 7183 cases with primary hyperparathyroidism were classified into HA (n = 381) and non‐HA (n = 6802) cohorts. HA patients had increased complications, including renal insufficiency (0.8% vs. 0.0%, p = 0.001), sepsis (1.0% vs. 0.1%, p = 0.003), pneumonia (0.8% vs. 0.1%, p = 0.018), acute renal failure (1.0% vs. 0.0%, p < 0.001), and unplanned intubation (1.3% vs. 0.2%, p = 0.004). HA patients had increased risk of death (1.6% vs. 0.1%, p < 0.001), prolonged LOS (40.9% vs. 6.3%, p < 0.001), and any complication (5.5% vs. 1.2%, p < 0.001). Adjusted binary logistic regression indicated HA patients experienced increased odds of progressive renal insufficiency (OR 18.396, 95% CI 1.844–183.571, p = 0.013), prolonged LOS (OR 4.892; 95% CI 3.571–6.703; p < 0.001), unplanned reoperation (OR 2.472; 95% CI 1.012–6.035; p = 0.047), and unplanned readmission (OR 3.541; 95% CI 1.858–6.748; p < 0.001). Conclusions HA may be associated with adverse complications in patients undergoing parathyroidectomy for primary hyperparathyroidism. Level of Evidence 3 Laryngoscope, 133:2035–2039, 2023

Preoperative Serum Albumin as Predictor of Outcomes After Thyroidectomy

“…While our study did not specify the indications for thyroidectomy, the presence of thyroid malignancy, hyperthyroidism, and hypothyroidism were included in propensity score matching. Our results are also similar to a study by Khawaja et al that reported comparable 30‐day mortality rates in patients, who are of a similar mean age, with and without hypoalbuminemia who underwent parathyroidectomy 21 …”

“…Our study also found a higher rate of VTE in the hypoalbuminemia cohort, which was also seen in hypoalbuminemia patients undergoing parathyroidectomy and colorectal surgery 21,29 . The risk of developing VTE is lower compared to the risk of postoperative hemorrhage so prophylaxis is not routinely indicated 30 .…”

“…An increased risk of sepsis has been observed in hypoalbuminemia patients who underwent parathyroidectomy. 21 On the other hand, the benefit of albumin administration for patients with sepsis is not clear as 1 study did not find improved rates of mortality in severely septic patients who received albumin in addition to normal fluids. 36 To our knowledge, this is the largest retrospective study of thyroidectomy patients which increases the generalizability of the results.…”

“…Our results are also similar to a study by Khawaja et al that reported comparable 30-day mortality rates in patients, who are of a similar mean age, with and without hypoalbuminemia who underwent parathyroidectomy. 21 Postoperative outcomes that were significantly increased in those with hypoalbuminemia include pneumonia, AKI, VTE, and SSI. Pneumonia is the third most common surgical complication and the overall complication rate after thyroidectomy is low, but pneumonia has been found to make up half of the reported complications.…”

“…[26][27][28] Our study also found a higher rate of VTE in the hypoalbuminemia cohort, which was also seen in hypoalbuminemia patients undergoing parathyroidectomy and colorectal surgery. 21,29 The risk of developing VTE is lower compared to the risk of postoperative hemorrhage so prophylaxis is not routinely indicated. 30 Liver and kidney diseases, which can alter albumin levels, were considered in propensity score matching, but information on disease severity is not known.…”