Abstract
Parathyroidectomy (PTX) is one of the most frequently performed surgeries in chronic kidney disease (CKD) patients. The objective of this study was to determine the intensive care unit (ICU) admission, mortality and hospital readmission rates within the 30-day postoperative period, and the total cost of the care episode and to determine possible prognostic factors in end-stage renal disease (ESRD) adult patients taken to PTX in the Colombian contributory health system. Methods. Retrospective cohort study of ESRD adult patients affiliated to the Colombian contributory health system, on dialysis for at least 3 months, undergoing PTX between January 1, 2012, and November 30, 2016. The clinical outcomes evaluated were rehospitalization at 30 days, hospital stay, and ICU requirement. The costs associated with the hospitalization event in which the PTX was performed from the perspective of the third payer were estimated. Results. The study included 478 patients. The mortality rate was 2.09 per 100 surgeries, the ICU admission rate was 32.64 per 100 surgeries, the 30-day hospital readmission percentage of the postoperative period was 16.74%, and the average length of hospital stay was 5.02 days. The median total costs of care for the entire procedure was USD $ 7,814.27 (p25-p75: 3,922.03–9,372.68), with significant regional differences. The geographical region was shown as a prognostic factor associated with clinical outcomes and the cost of care. Conclusions. There are large regional differences in readmission, ICU admission and mortality rates, and costs of dialysis ESRD patients undergoing PTX belonging to the Colombian contributory regime. The geographic region behaves as an independent predictor of clinical outcomes and costs.
Highlights
IntroductionEnd-stage renal disease (ESRD) patients on chronic dialysis for more than 90 days have a high prevalence of alterations in bone mineral metabolism; secondary hyperparathyroidism (HPT) is the most frequent form, and is associated with adverse outcomes that include accelerated atherosclerosis, uraemic bone disease, refractory anemia, impaired quality of life, and increased mortality [1, 2].erapeutic interventions are based on calcium supplements, vitamin D analogues, calcimimetics, and parathyroidectomy (PTX) in cases refractory to medical treatment [2, 3]. e incidence of PTX is 8.09–14.2 cases per 1000 patient-years, and in those on renal replacement therapy (RRT) for more than 10 years, the incidence increases to 30 cases per 1000 patient-years [4]. is rate has remained essentially unchanged in recent years despite advances in medical therapy [5, 6]
In the period of time described, 1815 PTXs were performed in the contributory health system, 478 of which were performed in End-stage renal disease (ESRD) patients who had been on chronic dialysis for more than 90 days, who were included in the study
The comorbidities reported in the Charlson index (CCI) was higher in the subgroup of 50–60 years (59.65%); those under 49 years most frequently had 0–2 indexes (64.29%). e most frequent comorbidity was arterial hypertension (36.19%), followed by diabetes mellitus (16.74%); of these, the majority were older than 60 years. 4.81% of the patients had a history of renal transplantation (Table 2). 63.80% of the PTXs were carried out in the Bogotaand Central regions, and the public insurer predominated (52.30%)
Summary
End-stage renal disease (ESRD) patients on chronic dialysis for more than 90 days have a high prevalence of alterations in bone mineral metabolism; secondary hyperparathyroidism (HPT) is the most frequent form, and is associated with adverse outcomes that include accelerated atherosclerosis, uraemic bone disease, refractory anemia, impaired quality of life, and increased mortality [1, 2].erapeutic interventions are based on calcium supplements, vitamin D analogues, calcimimetics, and parathyroidectomy (PTX) in cases refractory to medical treatment [2, 3]. e incidence of PTX is 8.09–14.2 cases per 1000 patient-years, and in those on renal replacement therapy (RRT) for more than 10 years, the incidence increases to 30 cases per 1000 patient-years [4]. is rate has remained essentially unchanged in recent years despite advances in medical therapy [5, 6]. End-stage renal disease (ESRD) patients on chronic dialysis for more than 90 days have a high prevalence of alterations in bone mineral metabolism; secondary hyperparathyroidism (HPT) is the most frequent form, and is associated with adverse outcomes that include accelerated atherosclerosis, uraemic bone disease, refractory anemia, impaired quality of life, and increased mortality [1, 2]. Colombia is a medium-income country with universal health coverage (97%), and has two health system affiliation regimes. Colombia is one of the few countries with a high universal health coverage rate in Latin America [10]. E objective of this work is to describe clinical outcomes and costs associated with PTX in dialysis ESRD patients and to determine whether sociodemographic factors and comorbidities behave as a prognostic factor for these outcomes in Colombia, a mediumincome country with universal health coverage There are no reports on clinical outcomes and costs in this population in Latin America. e objective of this work is to describe clinical outcomes and costs associated with PTX in dialysis ESRD patients and to determine whether sociodemographic factors and comorbidities behave as a prognostic factor for these outcomes in Colombia, a mediumincome country with universal health coverage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
