Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States

Kim, Sun Moon; Long, Jin; Montez‐Rath, Maria E.; Leonard, Mary B.; Norton, Jeffrey A.; Chertow, Glenn M.

doi:10.2215/cjn.10370915

Cited by 91 publications

(80 citation statements)

References 22 publications

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“…One study illustrated that the most predictive risk factors for complications following PTX was coronary artery disease, stroke, and chronic kidney disease in order of most to least predictive . Mortality rates have also been shown to be greater in patients with heart failure and peripheral vascular disease and less in patients with prior renal transplantation …”

Section: Introductionmentioning

confidence: 99%

Parathyroidectomy for the treatment of hyperparathyroidism: Thirty‐day morbidity and mortality

Tang¹,

Salapatas²,

Bonzelaar³

et al. 2017

The Laryngoscope

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Section: Introductionmentioning

confidence: 99%

Parathyroidectomy for the treatment of hyperparathyroidism: Thirty‐day morbidity and mortality

Tang¹,

Salapatas²,

Bonzelaar³

et al. 2017

The Laryngoscope

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“…However, it is reassuring to note that our sample size does roughly agree with a recent publication evaluating national trends in parathyroidectomy. 2 Finally, we could not capture patients who died outside of the hospital within 30 days.…”

Section: Discussionmentioning

confidence: 99%

Unplanned 30‐Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis

Ferrandino

Roof

et al. 2017

Otolaryngol.--head neck surg.

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Objective To examine rates of readmission after parathyroidectomy in chronic kidney disease patients and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study Setting Nationwide Readmissions Database Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in chronic kidney disease patients between 1/2013 - 11/2013. Patient, admission, and hospital-level characteristics were compared for patients with and without at least one unplanned thirty-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of thirty-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the thirty days after discharge, however readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5-6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% CI 1.55 – 7.05, P = 0.002) and 1.87 (95% CI 1.10 – 3.19, P = 0.02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR 2.53, 95% CI 1.07-5.95, P = 0.03) were associated with higher risk of readmission. Conclusion Post-parathyroidectomy readmission rates for chronic kidney disease patients are nearly 5-times that of the general population. Careful consideration of post-operative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.

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“…Anecdotally, physicians appear to have widely variable criteria regarding which patients they choose to refer for parathyroidectomy, at least in the US. Perhaps reflecting uncertainty over its role, rates of parathyroidectomy have changed substantially over time in recent decades [3]. While guidelines recommend parathyroidectomy in patients with severe SHPT [4], how it might be used most optimally is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis

et al. 2016

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BackgroundSecondary hyperparathyroidism (SHPT) is associated with adverse outcomes in patients receiving maintenance dialysis. Parathyroidectomy is a treatment for SHPT; whether parathyroidectomy utilization varies geographically in the US is unknown.MethodsA retrospective cohort analysis was undertaken to identify all patients aged 18 years or older who were receiving in-center hemodialysis between 2007 and 2009, were covered by Medicare Parts A and B, and had been receiving hemodialysis for at least 1 year. Parathyroidectomy was identified from inpatient claims using relevant International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Patient characteristics and End-Stage Renal Disease Network (a proxy for geography) were ascertained. Adjusted odds ratios for parathyroidectomy were estimated from a logistic model.ResultsA total of 286,569 patients satisfied inclusion criteria, of whom 4435 (1.5%) underwent PTX. After adjustment for a variety of patient characteristics, there was a 2-fold difference in adjusted odds of parathyroidectomy between the most- and least-frequently performing regions. Adjusted odds ratios were more than 20% higher than average in four networks, and more than 20% lower in four networks.ConclusionsParathyroidectomy use varies substantially by geography in the US; the factors responsible should be further investigated.

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Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States

Cited by 91 publications

References 22 publications

Parathyroidectomy for the treatment of hyperparathyroidism: Thirty‐day morbidity and mortality

Parathyroidectomy for the treatment of hyperparathyroidism: Thirty‐day morbidity and mortality

Unplanned 30‐Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis

Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis

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