Parathyroidectomy in the Elderly: Analysis of 7313 Patients

• Published in: The Journal of surgical research Vol. 170; no. 2; pp. 240 - 246
• Main Authors: Thomas, Daniel C., M.P.H, Roman, Sanziana A., M.D., F.A.C.S, Sosa, Julie A., M.D., M.A., F.A.C.S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier 01-10-2011
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Comorbidity; Endocrinopathies; Female; General aspects; Humans; Hyperparathyroidism, Primary - epidemiology; Hyperparathyroidism, Primary - surgery; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Morbidity; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroidectomy - statistics & numerical data; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Postoperative Complications - epidemiology; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; United States - epidemiology; United States; elderly patients; primary hyperparathyroidism; morbidity; outcomes; ACS-NSQIP; parathyroidectomy; Endocrinopathy; Human; Prognosis; Patient; morbidity; outcomes; Parathyroidectomy; Epidemiology; Morbidity; Medicine; Treatment; Parathyroid diseases; Surgery; Primary; Evolution; Elderly; Hyperparathyroidism
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2011.03.014

Background The elderly are the fastest growing subset of the U.S. population, and suffer most from primary hyperparathyroidism. This is the first multi-institutional study to characterize 30-d outcomes in elderly patients undergoing parathyroidectomy. Materials and Methods Patients who underwent parathyroidectomy for primary hyperparathyroidism in ACS-NSQIP, 2005-8, were stratified into age groups: 45–64, 65–79, and ≥80 y. Independent patient variables included gender, race, inpatient/outpatient type, anesthesia, ASA classification, functional status, and presence/absence of >30 conditions. Outcomes included overall/system-specific complications, return to the OR, operating times, LOS, 30-d mortality. Patients 65–79 and ≥80 y were compared with younger ones using multivariable linear and logistic regression. Results A total of 7313 patients were identified: 77.8% women, 77.2% White, and 95.6% underwent first-time parathyroidectomy. Patients 65–79 and ≥ 80y were more likely to have inpatient parathyroidectomies compared with younger patients (42.4%, 46.8% versus 36.0%) and higher ASA classification (42.4%, 59.8% versus 24.2%, all P < 0.01). Patients ≥ 80 y were less likely than those 45–64 y to receive general anesthesia (84.9% versus 89.8%, P < 0.01). Patients ≥ 65 y were more likely to have ≥1 complication (2.2% versus 1.3%, P < 0.01) and respiratory-specific complications compared with younger patients (0.9% versus 0.3%, P  < 0.01). Patients 65–79 and ≥80 y were more likely to have extended hospital stays (7.7%, 12.2% versus 6.5%, P < 0.01); mortality rate for patients ≥ 80 y was higher (0.8% versus <0.1%, P < 0.01). On multivariable analysis, patients ≥ 65 y had increased risks for overall/respiratory complications and extended hospital stays, (all  P < 0.01). Conclusions Elderly patients sustain more morbidity following parathyroidectomy. Advanced age may be an independent risk factor worth considering in surgical decision-making.