Parathyroidectomy for Secondary, Tertiary Hyperparathyroidism Increases Morbidity and Mortality

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Patients were most likely to undergo reoperation for hematoma and postoperative hemorrhage.
Patients were most likely to undergo reoperation for hematoma and postoperative hemorrhage.

Patients undergoing parathyroidectomy for treatment of secondary and tertiary hyperparathyroidism experienced greater rates of morbidity and mortality compared with patients with primary hyperparathyroidism, according to recent research published in the Laryngoscope.

Michael Friedman, MD, medical director at Chicago Ear, Nose, and Throat in Illinois, and colleagues analyzed 21,267 patients from the American College of Surgeons National Surgical Quality Improvement Program database undergoing parathyroidectomy (PTX) between 2006 and 2014 to treat hyperparathyroidism (HPT). Patients were divided into subgroups based on primary HPT, secondary HPT (2HPT), and tertiary HPT (3HPT).

The overall morbidity and mortality rate was 7.2%, which included a readmission rate of 1.8% (n=323), a reoperation rate of 1.9% (n=334), and a mortality rate of 0.21% (n=45). Patients with 2HPT had significantly higher complication rates compared with HPT and 3HPT patients (P <.05).

"Respiratory complications were the most common complications seen in 2HPT and 3HPT, which were quite rare in patients with 1HPT," Dr Friedman and colleagues wrote in their study. "It is worth noting that airway compromise is one of the more feared end points of hematoma formation, and thus, the higher respiratory complications rates seen in 2HPT and 3HPT may be associated with the higher rates of reoperation for hematoma formation or postoperative hemorrhage in the 2HPT and 3HPT group compared to the 1HPT group."

When undergoing PTX, there was a morbidity and mortality rate of 4.9% in patients with HPT (n=14,500) compared with a rate of 26.8% (n=1661) in patients with 2HPT and a rate of 21.8% (n=588) in patients with 3HPT. Patients were most likely to undergo reoperation for hematoma (7.2%) and postoperative hemorrhage (3.3%), whereas the most common reason for readmission was hypocalcemia (18.3%).

The researchers noted that elevated preoperative serum creatinine, hypertension, and alkaline phosphatase predicted a higher complication rate after undergoing PTX (P <.0001).

"This study brings a unique aspect of reporting morbidity and mortality after PTX in a format that compares the levels of HPT. Presentation of data in this way provides a holistic and comprehensive approach to evaluating PTX as it pertains to patient populations with varying degrees of comorbidities," Dr Friedman and colleagues wrote.

"Accordingly, surgeons would benefit from applying this knowledge to pay special attention to perioperative care of the patient population with 2HPT and 3HPT. Moreover, results of this study may be used to reassess the preoperative characteristics of these patients to weigh the costs and benefits of performing PTX."

Reference

Tang JA, Salapatas AM, Bonzelaar LB, et al. Parathyroidectomy for the treatment of hyperparathyroidism: thirty-day morbidity and mortality [published online May 11, 2017]. Laryngoscope. doi:10.1002/lary.26604

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