P24: Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: A risk-benefit analysis

Abstract

Background: Increasing number of octogenarians and nonagenarians are being diagnosed with primary hyperparathyroidism. The only effective cure for this disease is parathyroidectomy. However, many elderly patients are not referred for surgery due to medical co-morbidities and/or advanced age. The purpose of this study was to evaluate the benefits against the risks of parathyroidectomy in this patient population. Methods: From March 2001 to June 2006, 50 patients >80 years of age with primary hyperparathyroidism underwent parathyroidectomy by a single surgeon. Clinical presentation and surgical outcomes of all patients were evaluated. In addition, the standard form of the SF-36 Health Survey designed to measure patient QOL was distributed to a subset of patients. The survey was administered one week pre-operatively, one week post-operatively, and one year after surgery. Results: There were 45 females and 5 males with a mean age of 83±2 years. Patient co-morbidities included hypertension (72%), coronary artery disease (22%), diabetes mellitus (16%), chronic obstructive pulmonary disease (10%), and congestive heart failure (10%). Bone pain was the most common primary presenting symptom (44%), followed by fatigue (12%), confusion (6%), and joint pain (6%). There was a high incidence of obesity, with 17% having a BMI > 30. At the time of surgery, 90% underwent a minimally invasive parathyroidectomy while the remaining 10% underwent a traditional approach. Eleven patients (22%) had ectopic glands. The mean weight of resected glands was 707±145mg. The cure rate was 98% (49/50). There were 2 post-operative complications (4%): one patient with transient hypocalcemia and another with cellulites at an IV site. Of patients who completed the QOL surveys, the majority reported improvement in several parameters: 80% reported increased or sustained physical functioning, 73% reported equal or less body pain after surgery, 70% had sustained or increased social functioning, and 64% claimed improvement in mental health. Conclusions: Parathyroidectomy is a safe and effective procedure for octogenarians and nonagenarians with primary hyperparathyroidism. It has a high cure rate and appears to maintain or improve quality of life. Thus, the surgical benefits outweigh operative risks, making parathyroid surgery an excellent option for elderly patients over 80 years of age with primary hyperparathyroidism.