Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes
| Autor: | Julie Ann Sosa, Michael T. Stang, Kevin L. Anderson, Sanziana A. Roman, Randall P. Scheri, Ewa Ruel, Samantha M. Thomas, Linda M. Youngwirth, Mohamed A. Adam |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Parathyroidectomy endocrine system medicine.medical_specialty Total parathyroidectomy medicine.medical_treatment 030232 urology & nephrology Transplantation Autologous complex mixtures Subtotal Parathyroidectomy Parathyroid Glands 03 medical and health sciences 0302 clinical medicine medicine Humans Hyperparathyroidism Renal hyperparathyroidism business.industry General Medicine Middle Aged medicine.disease Autotransplantation Surgery Treatment Outcome 030220 oncology & carcinogenesis Kidney Failure Chronic Operative time Female Hyperparathyroidism Secondary Secondary hyperparathyroidism business |
| Zdroj: | The American Journal of Surgery. 214:914-919 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2017.07.018 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect