Changes in Prescribed Treatments Following Parathyroidectomy for Primary Hyperparathyroidism in Older Adults

Abstract

© The Author(s). Aim and objective: Primary hyperparathyroidism (PHPT) is associated with multiple comorbidities and diverse symptomology that often require management with prescribed medications. Parathyroidectomy is an established treatment for PHPT but may also reduce the need for medications required to treat the associated conditions. We examined the changes in dispensed drugs given to a cohort of older adults with PHPT before and following parathyroidectomy. Materials and methods: A publicly available administrative Pharmaceutical and Medical Benefits Scheme database was used for this study. Participants aged >45 years undergoing parathyroidectomy for PHPT were identified by procedure codes for the period 2008 to 2014. Anatomic Therapeutic Chemical codes (ATC) assigned to drugs prescribed to individual participants, pre-and postoperatively, were used to define therapeutic groups and calculate cohort prevalences. Changes in dispensed medications following parathyroidectomy were assessed by the modulation of ATC class prevalence estimates of drugs prescribed using the Autoregressive Integrated Moving Averages (ARIMA) time-series methodology. Results: Six hundred and ten persons aged >45 years (M 72.1, SD 7.0) undergoing parathyroidectomy for PHPT were recruited. Preoperative dispensed treatment prevalences were highest for agents acting on the renin–angiotensin system (48%), dyslipidemia (45%), acid disorders (37%), antibiotics (31%), and analgesics (20%). Treatment prevalences for all ATC defined medications remained either unchanged or increased 3 years postoperatively. Polypharmacy following surgery also increased from an average 5.9 (SD = 4.0, range 0–23) prescribed medications for chronic conditions preoperatively to 7.0 (SD = 4.0) at 2 years (p < 0.001). Conclusion: The prevalence of ATC classified drugs prescribed and dispensed for chronic conditions in older adults with PHPT changed minimally following parathyroidectomy and polypharmacy of dispensed medications increased. Clinical significance: Parathyroidectomy performed in older persons for PHPT has a limited impact on the prevalence of dispensed drugs used to treat many of the associated chronic conditions. Mesh: Big data; Chronic conditions; Drug utilization; Hyperparathyroidism; Polypharmacy; Primary; Surgery.