Jennifer Fieber1, Kristin Goodsell2, Rachel R Kelz1,2, Jae P Ermer1, Chris Wirtalla1, Douglas L Fraker1,2, Heather Wachtel3,4. 1. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Silverstein Pavilion, Philadelphia, PA, 19104, USA. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Silverstein Pavilion, Philadelphia, PA, 19104, USA. Heather.Wachtel@pennmedicine.upenn.edu. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Heather.Wachtel@pennmedicine.upenn.edu.
Abstract
BACKGROUND: Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT). METHODS: We performed a retrospective cohort study of patients undergoing parathyroidectomy for PHPT at a single center (1997-2015). Patients were classified by self-identified race, as African-American or White. The primary outcome was disease severity at referral. The secondary outcome was completeness of preoperative evaluation. Operative success and surgical cure were evaluated. RESULTS: A total of 2392 patients were included. The majority of patients (87.6%) were White. African-American patients had higher rates of comorbid disease as well as higher preoperative calcium (10.9 vs.10.8 mg/dl, p < 0.001) and PTH levels (122 vs. 97 pg/ml, p < 0.001). White patients were more likely to have history of bone loss documented by DXA and nephrolithiasis. African-American patients had lower rates of complete preoperative evaluation including DXA scan. Operatively, African-American patients had larger glands by size (1.7 vs. 1.5 cm, p < 0.001) and mass (573 vs. 364 mg, p < 0.001). We observed similar operative success (98.9 vs. 98.0%, p = 0.355) and cure rates (98.3 vs. 97.0%, p = 0.756). CONCLUSIONS: At the time of surgical referral, African-American patients with PHPT have more biochemically severe disease and higher rates of incomplete evaluation. Operative success and cure rates are comparable.
BACKGROUND: Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT). METHODS: We performed a retrospective cohort study of patients undergoing parathyroidectomy for PHPT at a single center (1997-2015). Patients were classified by self-identified race, as African-American or White. The primary outcome was disease severity at referral. The secondary outcome was completeness of preoperative evaluation. Operative success and surgical cure were evaluated. RESULTS: A total of 2392 patients were included. The majority of patients (87.6%) were White. African-American patients had higher rates of comorbid disease as well as higher preoperative calcium (10.9 vs.10.8 mg/dl, p < 0.001) and PTH levels (122 vs. 97 pg/ml, p < 0.001). White patients were more likely to have history of bone loss documented by DXA and nephrolithiasis. African-American patients had lower rates of complete preoperative evaluation including DXA scan. Operatively, African-American patients had larger glands by size (1.7 vs. 1.5 cm, p < 0.001) and mass (573 vs. 364 mg, p < 0.001). We observed similar operative success (98.9 vs. 98.0%, p = 0.355) and cure rates (98.3 vs. 97.0%, p = 0.756). CONCLUSIONS: At the time of surgical referral, African-American patients with PHPT have more biochemically severe disease and higher rates of incomplete evaluation. Operative success and cure rates are comparable.
Authors: Johan P Mackenbach; Irina Stirbu; Albert-Jan R Roskam; Maartje M Schaap; Gwenn Menvielle; Mall Leinsalu; Anton E Kunst Journal: N Engl J Med Date: 2008-06-05 Impact factor: 91.245
Authors: Géza Mózes; Kathleen J Curlee; Charles M Rowland; Jon A van Heerden; Geoffrey B Thompson; Clive S Grant; David R Farley Journal: J Am Coll Surg Date: 2002-02 Impact factor: 6.113
Authors: Michael W Yeh; Philip H G Ituarte; Hui Cynthia Zhou; Stacie Nishimoto; In-Lu Amy Liu; Avital Harari; Philip I Haigh; Annette L Adams Journal: J Clin Endocrinol Metab Date: 2013-02-15 Impact factor: 5.958
Authors: Mercedes R Carnethon; Jia Pu; George Howard; Michelle A Albert; Cheryl A M Anderson; Alain G Bertoni; Mahasin S Mujahid; Latha Palaniappan; Herman A Taylor; Monte Willis; Clyde W Yancy Journal: Circulation Date: 2017-10-23 Impact factor: 29.690
Authors: Wilson M Alobuia; Tong Meng; Robin M Cisco; Dana T Lin; Insoo Suh; Manjula Kurella Tamura; Amber W Trickey; Electron Kebebew; Carolyn D Seib Journal: Surgery Date: 2021-07-03 Impact factor: 3.982