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Patel AM, Shaari AL, Aftab OM, Lemdani MS, Choudhry HS, Filimonov A. Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy. Indian J Otolaryngol Head Neck Surg 2024; 76:1910-1920. [PMID: 38566654 PMCID: PMC10982178 DOI: 10.1007/s12070-023-04444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS ≥ 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization. Level of Evidence: IV. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04444-3.
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Affiliation(s)
- Aman M. Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Ariana L. Shaari
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Owais M. Aftab
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Mehdi S. Lemdani
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Hassaam S. Choudhry
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Andrey Filimonov
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA
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Bartz-Kurycki MA, Dream S, Yen TW, Doffek K, Shaker J, Evans DB, Wang TS. Older Patients With Asymptomatic Primary Hyperparathyroidism: Should Criteria for Surgery Be Expanded? J Endocr Soc 2023; 7:bvad098. [PMID: 37873505 PMCID: PMC10590644 DOI: 10.1210/jendso/bvad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 10/25/2023] Open
Abstract
Context Patients with primary hyperparathyroidism (PHPT) can present with variable signs, symptoms, and end-organ effects. Clinical practice guidelines influence referral for consideration of parathyroidectomy. Objective This study compared the demographic, biochemical, and symptom profile and examine indications for surgery in patients older than 50 years who underwent parathyroidectomy to determine how changes to current guidelines may affect recommendations for parathyroidectomy. Methods A retrospective review was conducted of patients age 50 years or older who underwent initial parathyroidectomy for sporadic PHPT from 2012 to 2020. Patients were classified by indications for surgery per guideline criteria (classic, asymptomatic, and no criteria met) and age group (AG): 50 to 59 years; 60 to 69 years; 70 years or older. Patients were treated at a high-volume tertiary medical center by endocrine surgeons. Results Of 1182 patients, 367 (31%) classic and 660 (56%) asymptomatic patients met the criteria for surgery. The most common indications for surgery were extent of hypercalcemia (51%), osteoporosis (28%), and nephrolithiasis (27%). Of the 155 (13%) patients who did not meet the criteria, neurocognitive symptoms (AG1: 88% vs AG2: 81% vs AG3: 70%; P = .14) and osteopenia (AG1: 53% vs AG2: 68% vs AG3: 68%; P = .43) were frequently observed regardless of patient age. If the age threshold of younger than 50 years was expanded to 60, 65, or 70 years, an additional 61 (5%), 99 (8%), and 124 (10%) patients in the entire cohort would have met the guideline criteria for surgery, respectively. Conclusion Expanding current guidelines for PHPT to include a broader age range, osteopenia, and neurocognitive symptoms may allow for earlier surgical referral and evaluation for definitive treatment.
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Affiliation(s)
| | - Sophie Dream
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tina W Yen
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kara Doffek
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Joseph Shaker
- Division of Endocrinology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Douglas B Evans
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tracy S Wang
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Maurer E, Bartsch DK. [Outpatient parathyroid gland operations in the German system-Feasible and useful?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01846-5. [PMID: 36897344 DOI: 10.1007/s00104-023-01846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND In 2019 approximately 7500 procedures were carried out for parathyroid diseases in Germany (Statistisches Bundesamt 2020, https://www.destatis.de/DE/ ). All operations were performed as inpatient procedures. The catalogue of outpatient procedures for 2023 does not include operations on the parathyroid glands. OBJECTIVE Which conditions are prerequisites for parathyroid surgery on an outpatient basis? MATERIAL AND METHODS Published data on outpatient parathyroid surgery were analyzed with respect to the underlying disease, procedures performed and patient-specific circumstances. RESULTS Initial operations for localized sporadic primary hyperparathyroidism (pHPT) seem to be suitable for outpatient surgery, provided that affected patients fulfil the general prerequisites for an outpatient operation. The procedures focused parathyroidectomy and unilateral exploration can be carried out using local or general anesthesia and have a very low risk for postoperative complications. The organization of the day of the operation and the postoperative treatment of the patient should be organized within a detailed standard of procedure. The remuneration for an outpatient parathyroidectomy is not included in the German outpatient surgery catalogue and is therefore currently not adequately financially reimbursed. CONCLUSION In selected patients a limited initial intervention for primary hyperparathyroidism can be safely performed on an outpatient basis; however, the present German reimbursement modalities have to be revised so that the cost of these outpatient operations can be adequately covered.
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Affiliation(s)
- Elisabeth Maurer
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland.
| | - Detlef K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland
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Lee WG, Gosnell JE, Shen WT, Duh QY, Suh I, Chen Y. Recovery After Thyroid and Parathyroid Surgery: How Do Our Patients Really Feel? J Surg Res 2023; 283:764-770. [PMID: 36470201 DOI: 10.1016/j.jss.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Counseling on the immediate postoperative experience for outpatient procedures is largely based on anecdotal experience. We devised a short messaging service (SMS) survey using mobile phone text messages to evaluate real-time patient recovery following outpatient thyroid or parathyroid surgery. MATERIALS AND METHODS Daily automated SMS surveys were sent the evening of the operation until postoperative day 10. Pain, opioid use, voice quality, and energy levels were assessed. Impaired voice and energy was defined as a score < 2/3 of normal. RESULTS One hundred fifty five patients were enrolled with an overall response rate of 81.6%. One hundred thirty three patients had an individual response rate > 50% and were included in the final analysis. Median patient age was 60 y with 102 females (76.7%). Seventy patients (52.6%) underwent parathyroidectomy and 66 (49.6%) thyroidectomy and 10 (7.5%) neck dissection. Forty eight patients (36.1%) did not use any opioids postoperatively. Independent risk factors for higher total pain scores included thyroidectomy and patients with preoperative opioid or tobacco use, while increased opioid use was associated with age < 60 y, body mass index > 30 kg/m2, preoperative opioid or tobacco use, and history of anxiety or depression. Patients with loss of intraoperative recurrent laryngeal nerve signaling had a significantly worse overall voice score (54.65 versus 92.67, P < 0.001). Up to 10% of patients were still using opioids and/or reported impaired voice and energy levels beyond 1 wk postoperatively. CONCLUSIONS Real-time SMS survey is an effective and potentially valuable way to monitor patient recovery following surgery. A subset of patients reported impaired voice and energy and was still using opioids beyond 1 wk after thyroid and parathyroid surgery and these patients may benefit from closer follow-up and earlier intervention.
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Affiliation(s)
- William G Lee
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California
| | - Jessica E Gosnell
- University of San Francisco, Section of Endocrine Surgery, San Francisco, California
| | - Wen T Shen
- University of San Francisco, Section of Endocrine Surgery, San Francisco, California
| | - Quan-Yang Duh
- University of San Francisco, Section of Endocrine Surgery, San Francisco, California
| | - Insoo Suh
- NYU Langone Health, Division of Endocrine Surgery, New York, New York
| | - Yufei Chen
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, California.
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Kadoor AS, Patel K, Burton BN, Gabriel RA. Class 3 obesity is not associated with same-day admission in obese patients undergoing parathyroidectomy. J Clin Anesth 2021; 75:110472. [PMID: 34332495 DOI: 10.1016/j.jclinane.2021.110472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Rising rates of obesity and outpatient performance of parathyroidectomies are making it increasingly crucial to investigate the association of obesity with post-operative complications. OBJECTIVE To determine whether Class 3 obesity is associated with increased same-day admission compared to lower obesity classes following outpatient parathyroidectomy. DESIGN Retrospective cohort study. SETTING Outpatient surgery. PATIENTS 12,973 patients ≥18 years old who underwent outpatient parathyroidectomy between 2014 and 2016, per the American College of Surgeons National Surgical Quality Improvement Program registry. INTERVENTIONS Primary exposure variable: body mass index (BMI), with patients assigned to one of six cohorts. MEASUREMENTS Primary outcome measure: same-day admission. Secondary outcome measure: 30-day readmission. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). MAIN RESULTS There was a final sample size of 12,973 adult patients who underwent parathyroidectomy from 2014 to 2016. The admission rate for BMI ≥30 and < 40 kg/m2 (reference cohort) was 42.6%. The admission rates for Class 3 obesity categories were 46.2%, 56.2%, and 52.6% for those in the BMI range of ≥40 kg/m2 and < 50 kg/m2, ≥50 kg/m2 and < 60 kg/m2, and ≥ 60 kg/m2, respectively. On multivariable logistic regression, there were no difference in the odds of 30-day hospital admission or readmission rate with any of the BMI cohorts when compared to the reference group. CONCLUSIONS There is no significant difference in rates of same-day admission or 30-day readmission between any Class 3 (BMI ≥40 kg/m2) obesity cohort and the Class 1 and 2 (BMI ≥30 and < 40 kg/m2) reference cohort following outpatient parathyroidectomy. This corroborates the notion that BMI classes cannot be used in a vacuum to determine eligibility for outpatient parathyroidectomy - a concept that can guide safe and cost-effective institutional practices.
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Affiliation(s)
- Adarsh S Kadoor
- School of Medicine, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA).
| | - Kruti Patel
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA.
| | - Brittany N Burton
- Department of Anesthesiology, University of California, Los Angeles (405 Hilgard Avenue), Los Angeles, CA 90095, USA.
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA.
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Gawrychowski J, Kowalski GJ, Buła G, Bednarczyk A, Żądło D, Niedzielski Z, Gawrychowska A, Koziołek H. Surgical Management of Primary Hyperparathyroidism-Clinicopathologic Study of 1019 Cases from a Single Institution. J Clin Med 2020; 9:jcm9113540. [PMID: 33147842 PMCID: PMC7693783 DOI: 10.3390/jcm9113540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95-98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. METHODS We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983-2018. RESULTS Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. CONCLUSIONS Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.
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Walsh NJ, Sullivan BT, Duke WS, Terris DJ. Routine bilateral neck exploration and four-gland dissection remains unnecessary in modern parathyroid surgery. Laryngoscope Investig Otolaryngol 2018; 4:188-192. [PMID: 30828638 PMCID: PMC6383449 DOI: 10.1002/lio2.223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/27/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022] Open
Abstract
Objective Recent advances in preoperative imaging techniques and intraoperative parathyroid hormone (ioPTH) assays have made single-gland, minimally invasive parathyroidectomy (MIP) the preferred treatment option for most patients with primary hyperparathyroidism (pHPT). Despite this evolution, a recommendation for bilateral neck exploration (BNE) with four-gland dissection in all patients has recently been advocated by a parathyroid surgical group. The current study compares the long-term outcomes of MIP with those of conventional BNE with four-gland dissection in patients with pHPT. Methods In order to objectively assess a recommendation in the literature that universal BNE with four-gland dissection is advisable, all patients undergoing an initial MIP with ioPTH assessment for pHPT in a tertiary endocrine practice during a 10-year period were reviewed. The cure rates from this procedure were compared with published results of conventional BNE with four-gland dissection. Results Of the 561 patients undergoing parathyroidectomy during the study period, 337 had initial surgery for pHPT; 282 of these patients met inclusion criteria and 212 had sufficient follow-up data available. A single adenoma was identified in 87.3% of cases. Preoperative imaging studies were co-localizing in 148 (69.8%), and 127 (85.8%) of these patients with co-localizing imaging required only single-gland surgery. Imaging studies did not co-localize in 49 patients, yet 32 (65.3%) of these patients were still cured with unilateral surgery. The cure rate for patients undergoing MIP was 98.6%, with a long-term recurrence rate of <2%. Conclusion When coupled with the ioPTH assay, patients with at least one preoperative localizing study can undergo MIP and anticipate a cure rate of 99%, which is as good as or better than the published rates for conventional BNE with four-gland dissection. With unilateral surgery, the risks of permanent hypoparathyroidism and airway obstruction from bilateral vocal fold paralysis are completely eliminated. Therefore, despite recommendations to the contrary, most patients with pHPT should not have a planned four-gland exploration. Level of Evidence III or IV.
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Affiliation(s)
- Nathaniel J Walsh
- Department of Otolaryngology-Head and Neck Surgery Augusta University Augusta Georgia
| | - Brian T Sullivan
- Department of Otolaryngology-Head and Neck Surgery Augusta University Augusta Georgia
| | - William S Duke
- Department of Otolaryngology-Head and Neck Surgery Augusta University Augusta Georgia
| | - David J Terris
- Department of Otolaryngology-Head and Neck Surgery Augusta University Augusta Georgia
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Lou I, Chennell TB, Schaefer SC, Chen H, Sippel RS, Balentine C, Schneider DF, Moalem J. Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience. Ann Surg Oncol 2017; 24:1951-1957. [PMID: 28160140 DOI: 10.1245/s10434-017-5781-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroidectomy and parathyroidectomy are the most commonly performed endocrine operations, and are increasingly being completed on a same-day basis; however, few data exist regarding the outpatient postoperative pain requirement of these patients. We aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement. METHOD We examined patients undergoing thyroid and parathyroid surgery at two large academic institutions from 1 January-30 May 2014. Prospective data were collected on pain scores and the oral morphine equivalents (OMEQs) taken by these patients by their postoperative visit. RESULTS Overall, 313 adult patients underwent thyroidectomy or parathyroidectomy during the study period; 83% of patients took ten or fewer OMEQs, and 93% took 20 or fewer OMEQs. Patients who took more than ten OMEQs were younger (p < 0.001) and reported significantly higher overall mean pain scores at their postoperative visit (p < 0.001) than patients who took fewer than ten OMEQs. A multivariate model was constructed on pre- and intraoperative factors that may predict use of more than ten OMEQs postoperatively. Age <45 years (p = 0.002), previous narcotic use (p = 0.037), and whether parathyroid or thyroid surgery was performed (p = 0.003) independently predicted the use of more than ten OMEQs after surgery. A subgroup analysis was then performed on thyroidectomy-only patients. CONCLUSION Overall, 93% of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer OMEQs by their postoperative visit. We therefore recommend these patients be discharged with 20 OMEQs, both to minimize waste and increase patient safety.
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Affiliation(s)
- Irene Lou
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.,Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Todd B Chennell
- Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Sarah C Schaefer
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Herbert Chen
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.,Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca S Sippel
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Courtney Balentine
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.,Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David F Schneider
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Jacob Moalem
- Department of Surgery, University of Rochester, Rochester, NY, USA.
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Jha CK, Bichoo RA, Yadav SK, Sonthineni C, Bothra S. Ambulatory bilateral neck exploration for primary hyperparathyroidism: Is it safe? Am J Surg 2016; 213:1191-1192. [PMID: 27863721 DOI: 10.1016/j.amjsurg.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Chandan Kumar Jha
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Raouef Ahmed Bichoo
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Kumar Yadav
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Chaitra Sonthineni
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sapana Bothra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Kim SM, Shu AD, Long J, Montez-Rath ME, Leonard MB, Norton JA, Chertow GM. Declining Rates of Inpatient Parathyroidectomy for Primary Hyperparathyroidism in the US. PLoS One 2016; 11:e0161192. [PMID: 27529699 PMCID: PMC4986953 DOI: 10.1371/journal.pone.0161192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Aimee D. Shu
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jin Long
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mary B. Leonard
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jeffrey A. Norton
- Department of Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Glenn M. Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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