Decreasing Surgical Management of Secondary Hyperparathyroidism in the United States
| Autor: | Jeffrey H. William, Chun Li, Scott C Fligor, Benjamin C. James, Ryoko Hamaguchi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Parathyroidectomy
Male medicine.medical_specialty Cinacalcet medicine.medical_treatment Subgroup analysis Disease Calcimimetic Agents End stage renal disease 03 medical and health sciences 0302 clinical medicine Postoperative Complications Weight loss Internal medicine medicine Humans Hospital Mortality Practice Patterns Physicians' Referral and Consultation business.industry Middle Aged medicine.disease United States 030220 oncology & carcinogenesis Practice Guidelines as Topic Etiology Kidney Failure Chronic 030211 gastroenterology & hepatology Surgery Secondary hyperparathyroidism Female Hyperparathyroidism Secondary medicine.symptom business Administrative Claims Healthcare medicine.drug |
| Zdroj: | The Journal of surgical research. 264 |
| ISSN: | 1095-8673 |
| Popis: | Background Secondary hyperparathyroidism (SHPT) commonly occurs in end-stage renal disease (ESRD), leading to vascular calcification and increased mortality. For SHPT refractory to medical management, parathyroidectomy improves symptoms and decreases mortality. Medical management has changed with the release of new guidelines and advent of novel medications. We investigate recent national trends in parathyroidectomy for SHPT. Materials and methods We used the National/Nationwide Inpatient Sample from 2004 to 2016 to identify hospitalizations including parathyroidectomy for SHPT and calculated parathyroidectomy rates utilizing data from the United States Renal Data System. Subgroup analysis was conducted by race. Risk factors for in-hospital mortality were identified with purposeful selection and multivariable logistic regression. Results From 2004 to 2016, the rate of parathyroidectomies for SHPT per 1000 ESRD patients decreased from 6.07 (95% CI: 4.83-7.32) to 3.67 (95% CI: 3.33-4.00). Black patients underwent parathyroidectomy for SHPT at a 1.8-fold higher rate than white and Hispanic patients (5.59 versus 3.04 and 3.07). Almost all tracked comorbidities increased in prevalence. In-hospital mortality trended lower (1.5% to 0.8%, P = 0.051). Risk factors for in-hospital mortality included weight loss (OR 4.19, 95% CI: 2.00-8.78) and cardiac arrhythmia (OR 3.38, 95% CI: 1.66-6.91), while additional calendar year (OR = 0.87, 95% CI: 0.80-0.95) was protective. Conclusions The etiology of the declining parathyroidectomy rate for SHPT is unclear; possible factors include changing guidelines emphasizing medical management, widespread availability of cinacalcet, changing practice patterns, and inadequate surgical referral. |
| Databáze: | OpenAIRE |
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