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Introduction. Many elderly patients with primary hyperparathyroidism (HPT), which increases in incidence with age and is frequently asymptomatic, are often not referred for surgery. However, the development of minimally invasive techniques has facilitated complex operations even in the elderly. Therefore, we sought to determine if the introduction of minimally invasive radioguided parathyroidectomy (MIRP) would alter the threshold for surgical referral at our institution for patients over 70 years of age. Methods. From January 1990 to March 2004, 422 patients underwent surgery for primary HPT at our institution. Of these, 98 were 70 years or older. In 2001, we introduced MIRP. Patients were then analyzed based upon the availability of this technology (pre-MIRP era 1990–2000, and MIRP era 2001–2004). Results. In the MIRP era, more elderly patients were referred for surgery when compared to the pre-MIRP era (30% versus 18%, P = 0.001). On average, 18 elderly patients/year had parathyroid surgery in the MIRP era compared to only 3 elderly patients/year pre-MIRP, representing a 6-fold increase. Furthermore, there were significantly more patients undergoing parathyroidectomy who were asymptomatic from HPT during the MIRP era (14% versus TABLE—ABSTRACT 33 . ERA N Cure rate Complications Hospital stay (days) Pre-MIRP 43 89% 7% 2.0 ± 0.4 MIRP 55 99% 3% 0.5 ± 0.1 p value — 0.05 |
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