Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Anderson, K; Ruel, E; Adam, MA; Thomas, S; Youngwirth, L; Stang, MT; Scheri, RP; Roman, SA; Sosa, JA

Published Date

  • November 2017

Published In

Volume / Issue

  • 214 / 5

Start / End Page

  • 914 - 919

PubMed ID

  • 28736060

Electronic International Standard Serial Number (EISSN)

  • 1879-1883

International Standard Serial Number (ISSN)

  • 0002-9610

Digital Object Identifier (DOI)

  • 10.1016/j.amjsurg.2017.07.018

Language

  • eng