Background
It remains unclear whether total or subtotal parathyroidectomy for secondary hyperparathyroidism
yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture,
and recurrent parathyroidectomy after total versus subtotal parathyroidectomy in patients
on renal replacement therapy.
Methods
Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid
surgery, and the National Inpatient Registry, we identified patients who underwent
parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total
versus subtotal parathyroidectomy using COX's regression, adjusting for age, sex,
cause of renal disease, time with a functioning graft before and after parathyroidectomy,
Charlson comorbidity index, year of surgery, prevalent cardiovascular disease, time
on dialysis, renal transplantation at parathyroidectomy, and treatment with calcimimetics
before parathyroidectomy.
Results
There were 824 patients who underwent parathyroidectomy, 388 total and 436 subtotal.
There was no difference in mortality or risk of incident hip fracture between groups.
Comparing the subtotal with the total parathyroidectomy, the adjusted hazard ratio
(95% confidence interval) for cardiovascular events was 0.43 (0.25–0.72) and for recurrent
parathyroidectomy 3.33 (1.33–8.32).
Conclusion
There was a higher risk of cardiovascular events in patients after total parathyroidectomy
compared with subtotal parathyroidectomy, but a lower risk of recurrent parathyroidectomy.
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Article info
Publication history
Published online: November 06, 2018
Accepted:
April 15,
2018
Received in revised form:
April 6,
2018
Received:
January 29,
2018
Footnotes
Presented at the 2018 Annual Meeting of the American Association of Endocrine Surgeons.
Supported by the Swedish Kidney Association Foundation, Skåne University Hospital Research Trust Funds, The Anna Lisa and Sven-Erik Lundgren Foundation for Medical Research, Southern Health Care Region Grants, and Lund University Faculty of Medicine Research Grants.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
