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Total versus subtotal parathyroidectomy for secondary hyperparathyroidism

Isaksson, Elin LU ; Ivarsson, Kerstin LU ; Akaberi, Shahriar LU ; Muth, Andreas; Prütz, Karl Göran; Clyne, Naomi LU ; Sterner, Gunnar LU and Almquist, Martin LU (2019) In Surgery (United States) 165(1). p.142-150
Abstract

Background: It remains unclear whether total or subtotal parathyroidectomy for secondary hyperparathyroidism yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture, and recurrent parathyroidectomy after total versus subtotal parathyroidectomy in patients on renal replacement therapy. Methods: Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid surgery, and the National Inpatient Registry, we identified patients who underwent parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total versus subtotal parathyroidectomy using COX's regression, adjusting for age, sex, cause of renal disease, time with a functioning graft before and after... (More)

Background: It remains unclear whether total or subtotal parathyroidectomy for secondary hyperparathyroidism yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture, and recurrent parathyroidectomy after total versus subtotal parathyroidectomy in patients on renal replacement therapy. Methods: Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid surgery, and the National Inpatient Registry, we identified patients who underwent parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total versus subtotal parathyroidectomy using COX's regression, adjusting for age, sex, cause of renal disease, time with a functioning graft before and after parathyroidectomy, Charlson comorbidity index, year of surgery, prevalent cardiovascular disease, time on dialysis, renal transplantation at parathyroidectomy, and treatment with calcimimetics before parathyroidectomy. Results: There were 824 patients who underwent parathyroidectomy, 388 total and 436 subtotal. There was no difference in mortality or risk of incident hip fracture between groups. Comparing the subtotal with the total parathyroidectomy, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 0.43 (0.25–0.72) and for recurrent parathyroidectomy 3.33 (1.33–8.32). Conclusion: There was a higher risk of cardiovascular events in patients after total parathyroidectomy compared with subtotal parathyroidectomy, but a lower risk of recurrent parathyroidectomy.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Surgery (United States)
volume
165
issue
1
pages
142 - 150
publisher
Elsevier
external identifiers
  • scopus:85056002483
ISSN
0039-6060
DOI
10.1016/j.surg.2018.04.076
language
English
LU publication?
yes
id
fafdc8ae-20d5-4c4c-af27-daac8315698d
date added to LUP
2018-11-19 15:00:23
date last changed
2019-05-21 04:15:10
@article{fafdc8ae-20d5-4c4c-af27-daac8315698d,
  abstract     = {<p>Background: It remains unclear whether total or subtotal parathyroidectomy for secondary hyperparathyroidism yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture, and recurrent parathyroidectomy after total versus subtotal parathyroidectomy in patients on renal replacement therapy. Methods: Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid surgery, and the National Inpatient Registry, we identified patients who underwent parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total versus subtotal parathyroidectomy using COX's regression, adjusting for age, sex, cause of renal disease, time with a functioning graft before and after parathyroidectomy, Charlson comorbidity index, year of surgery, prevalent cardiovascular disease, time on dialysis, renal transplantation at parathyroidectomy, and treatment with calcimimetics before parathyroidectomy. Results: There were 824 patients who underwent parathyroidectomy, 388 total and 436 subtotal. There was no difference in mortality or risk of incident hip fracture between groups. Comparing the subtotal with the total parathyroidectomy, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 0.43 (0.25–0.72) and for recurrent parathyroidectomy 3.33 (1.33–8.32). Conclusion: There was a higher risk of cardiovascular events in patients after total parathyroidectomy compared with subtotal parathyroidectomy, but a lower risk of recurrent parathyroidectomy.</p>},
  author       = {Isaksson, Elin and Ivarsson, Kerstin and Akaberi, Shahriar and Muth, Andreas and Prütz, Karl Göran and Clyne, Naomi and Sterner, Gunnar and Almquist, Martin},
  issn         = {0039-6060},
  language     = {eng},
  number       = {1},
  pages        = {142--150},
  publisher    = {Elsevier},
  series       = {Surgery (United States)},
  title        = {Total versus subtotal parathyroidectomy for secondary hyperparathyroidism},
  url          = {http://dx.doi.org/10.1016/j.surg.2018.04.076},
  volume       = {165},
  year         = {2019},
}