Abstract
Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years.
Highlights
Primary hyperparathyroidism is a common endocrine disorder characterized by chronically elevated serum calcium and increased or inappropriately normal parathyroid hormone (PTH) concentrations
In 2004, the calcimimetic cinacalcet was introduced in the United States (US) for secondary hyperparathyroidism, and by 2011 gained additional US Food and Drug Administration (FDA) approval for patients with primary hyperparathyroidism complicated by severe hypercalcemia but unable to undergo surgery
We identified 24,012 hospitalizations including parathyroidectomy, excluding thyroid or parathyroid cancer, sHPT, or age/sex missing from the Nationwide Inpatient Sample (NIS) between 2002 and 2011
Summary
Primary hyperparathyroidism (pHPT) is a common endocrine disorder characterized by chronically elevated serum calcium and increased or inappropriately normal parathyroid hormone (PTH) concentrations. The clinical profile has shifted from a symptomatic disorder, with hypercalcemic symptoms, kidney stones, or overt bone disease, toward an asymptomatic state, which represents the majority nowadays [2,3]. Parathyroidectomy generally cures the disease, decreases the risk of kidney stones, and improves bone mineral density (BMD) [4,5,6]. With respect to referral for surgical intervention, the 2002 guidelines suggested two modifications: lowering the threshold serum calcium concentration to 1.0 mg/dL greater than the upper limit of normal and lowering the bone densitometry consideration to a T-score of
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
