Comparison of Outcome Between Older and Younger Patients Following Surgery for Primary Hyperparathyroidism
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The aim of the study was to compare preoperative findings, serum levels of calcium and parathormone (PTH) and outcome of patients undergoing surgery for primary hyperparathyroidism (pHPT) aged over 70 years with younger patients. Material and methods. Between January 1, 1996 and September 30, 2011 186 patients underwent surgery for pHPT. Patient data were collected from chart reviews and an electronically stored database. Groups were defined as patients aged 70 years or older and patients younger than 70 years. Outcome comparison included operation time, tumor size, pre- and postoperative serum levels of calcium and PTH and length of stay in hospital. Complications were defined as clinical and laboratory signs of hypocalcemia, persistent elevated serum calcium, temporary or persistent recurrent laryngeal nerve paralysis, bleeding with need for reoperation, surgical site infection or need of tracheotomy. Results. Parathyroidectomy alone was performed in 39.2% of patients. In 60.8% partial or total thyroidectomy was conducted simultaneously. More older patients had history of stroke and/or suffered from diabetes. Preoperative serum calcium and PTH did not differ between groups, but older patients displayed higher postoperative serum calcium (p=0.01). No significant differences between the two groups were observed regarding duration of surgery, surgical success rates, postoperative complications and hospitalization time. Conclusions. Even though older patients had more risk factors, our data suggest that there was no difference in surgical management and outcome. Decision for surgical management of pHPT should be done regardless of age.
1 - 10 - 2013
01 - 12 - 2013
- 1. Vaz A, Griffiths M Parathyroid imaging and localization using SPECTCT initial results. J Nucl Med Technol 2011; 39(3) 195-200.[Crossref]
- 2. Agcaoglu O, Aliyev S, Heiden K et al. A new classification of positive sestamibi and ultrasound scans in parathyroid localization. World J Surg 2012; 36(10) 2516-21.[Crossref][WoS][PubMed]
- 3. Agha A, Hornung M, Rennert J et al. Contrast- enhanced ultrasonography for localization of pathologic glands in patients with primary hyperparathyroidism. Surgery 2012; 151(4) 580-86.[WoS]
- 4. Nagar S, Reid D, Czako P et al. Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism. Am J Surg 2012; 203(2) 177-81.
- 5. Procter LD, Davenport DL, Bernard AC et al. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 2010; 210(1) 60-65.
- 6. Adami S, Marcocci C, Gatti D Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002; 17 Suppl 2 18-23.
- 7. Geubbels EL , Mintjes-de Groot AJ, van den Berg JM et al. An operating surveillance system of surgical site infections in the Netherlands. Results of the PREZIES national surveillance network. Infect Control Hosp Epidemiol 2000; 21(5) 311-18.
- 8. Grogan RH, Mitmaker EJ, Hwang J et al. A population- based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab 2012; 97(5) 1645-53.[Crossref][WoS][PubMed]
- 9. Young VN, Osborne KM, Fleming MM et al. Parathyroidectomy in the elderly population does age really matter Laryngoscope 2010; 120(2) 247-52.
- 10. Brandt C, Hansen S, Sohr D et al. Finding a method for optimizing risk adjustment when comparing surgical-site infection rates. Infect Control Hosp Epidemiol 2004; 25(4) 313-18.
- 11. McConnell YJ, Johnson PM, Porter GA Surgical site infections following colorectal surgery in patients with diabetes association with postoperative hyperglycemia. J Gastrointest Surg 2009; 13(3) 508-15.[Crossref][WoS][PubMed]
- 12. Egan KR , Adler JT, Olson JE et al. Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians a risk-benefit analysis. J Surg Res 2007; 140(2) 194-98.
- 13. Bachar G, Gilat H, Mizrachi A et al. Comparison of perioperative management and outcome of parathyroidectomy between older and younger patients. Head Neck 2008; 30(11) 1415-21.[Crossref][WoS]
- 14. Wagner B, Begic-Karup S, Raber W et al. Prevalence of primary hyperparathyroidism in 13387 patients with thyroid diseases, newly diagnosed by screening of serum calcium. Exp Clin Endocrinol Diabetes 1999; 107(7) 457-61.
- 15. Leitha T, Staudenherz A Concomitant hyperparathyroidism and nonmedullary thyroid cancer, with a review of the literature. Clin Nucl Med 2003; 28(2) 113-17.[Crossref][PubMed]
- 16. Périé S, Aït-Mansour A, Devos M et al. Value of recurrent laryngeal nerve monitoring in the operative strategy during total thyroidectomy and parathyroidectomy. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130(3) 131-36.
- 17. Thomusch O, Sekulla C, Ukkat J et al. Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients. Zentralbl Chir 2001; 126(9) 664-71.
- 18. Zarebczan B, Chen H Influence of surgical volume on operative failures for hyperparathyroidism. Adv Surg 2011; 45 237-48.[PubMed][Crossref]
- 19. Babińska D, Barczyński M, Stefaniak T et al. Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism. Langenbecks Arch Surg 2012; 397(5) 825-31.[WoS]
- 20. Chen H Surgery for primary hyperparathyroidism what is the best approach Ann Surg 2002; 236(5) 552-53.
- 21. Barczyński M, Cichon S, Konturek A et al. Comparison of two techniques of minimally invasive parathyreoidectomy Video-assisted (MIVAP) and open (OMIP). Pol Przegl Chir 2007; 79 701-10.
- 22. Udelsman R, Donovan PI, Sokoll LJ One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 2000; 232(3) 331-39.
- 23. Barczyński M, Konturek A, Stopa M et al. Minimally invasive video-assisted thyroidectomy seven-year experience with 240 cases. Wideochir Inne Tech Malo Inwazyjne 2012; 7(3) 175-80. doi 10.5114wiitm.2011.28871.
- 24. Starup-Linde J, Waldhauer E, Rolighed L et al. Renal stones and calcifications in patients with primary hyperparathyroidism associations with biochemical variables. Eur J Endocrinol 2012; 166(6) 1093-1100.[WoS]
- 25. Silverberg SJ, Shane E, Jacobs TP et al. A 10- year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341(17) 1249-55.
- 26. Vestergaard P, Mollerup CL , Frøkjaer VG et al. Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ 2000; 321(7261) 598-602.
- 27. Clarke BL Epidemiology of primary hyperparathyroidism. J Clin Densitom 2013; 16(1) 8-13. [WoS][PubMed][Crossref]
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