Kevin Anderson1, Ewa Ruel2, Mohamed A Adam3, Samantha Thomas4, Linda Youngwirth3, Michael T Stang5, Randall P Scheri6, Sanziana A Roman6, Julie A Sosa7. 1. Duke University School of Medicine, Durham, NC, 27703, USA. 2. Endocrinology Associates of Princeton, Princeton, NJ, 08540, USA. 3. Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA. 4. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA. 5. Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA. Electronic address: michaelt.stang@duke.edu. 6. Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA. 7. Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA; Duke Cancer Institute, Durham, NC, 27710, USA; Duke Clinical Research Institute, Durham, NC, 27705, USA.
Abstract
BACKGROUND: The optimal surgery for patients with renal hyperparathyroidism has been controversial, as either subtotal parathyroidectomy (subtotal PTX) or total parathyroidectomy with auto-transplantation (total PTX-AT) may be employed. METHODS: Adult patients having subtotal PTX or total PTX-AT for secondary hyperparathyroidism were identified from the American College of Surgeons National Surgical Quality Improvement Program, 2005-2013. RESULTS: Of 1130 patients, the majority (n = 765, 68%) underwent subtotal PTX. Total PTX-AT was associated with longer operative time (median 150 vs. 120 min, p < 0.001). Rates of complications, reoperation, readmission, and 30-day mortality were not significantly different. After adjustment, the odds of having a complication [OR 0.97, p = 0.88] and being readmitted within 30 days [OR 0.86 p = 0.62] were similar between the two procedures. Total PTX-AT was associated with prolonged hospital stay [Adjusted mean 5.0 vs. 4.1 days; (RR) 1.22, p < 0.001] compared to subtotal PTX. CONCLUSIONS: Subtotal PTX and total PTX-AT have similar rates of complications, readmission, and 30-day mortality, but subtotal PTX is less likely to have extended hospital stay. These findings have important cost implications for patients, payers, and hospitals.
BACKGROUND: The optimal surgery for patients with renal hyperparathyroidism has been controversial, as either subtotal parathyroidectomy (subtotal PTX) or total parathyroidectomy with auto-transplantation (total PTX-AT) may be employed. METHODS: Adult patients having subtotal PTX or total PTX-AT for secondary hyperparathyroidism were identified from the American College of Surgeons National Surgical Quality Improvement Program, 2005-2013. RESULTS: Of 1130 patients, the majority (n = 765, 68%) underwent subtotal PTX. Total PTX-AT was associated with longer operative time (median 150 vs. 120 min, p < 0.001). Rates of complications, reoperation, readmission, and 30-day mortality were not significantly different. After adjustment, the odds of having a complication [OR 0.97, p = 0.88] and being readmitted within 30 days [OR 0.86 p = 0.62] were similar between the two procedures. Total PTX-AT was associated with prolonged hospital stay [Adjusted mean 5.0 vs. 4.1 days; (RR) 1.22, p < 0.001] compared to subtotal PTX. CONCLUSIONS: Subtotal PTX and total PTX-AT have similar rates of complications, readmission, and 30-day mortality, but subtotal PTX is less likely to have extended hospital stay. These findings have important cost implications for patients, payers, and hospitals.
Authors: Thomas Burgstaller; Andreas Selberherr; Lindsay Brammen; Christian Scheuba; Klaus Kaczirek; Philipp Riss Journal: Langenbecks Arch Surg Date: 2018-12-05 Impact factor: 3.445