Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Res. 2014 Aug;190(2):554-8. doi: 10.1016/j.jss.2014.05.027. Epub 2014 May 20.
The optimal surgical treatment for secondary hyperparathyroidism is not well defined. Subtotal parathyroidectomy and total parathyroidectomy (tPTX) with autotransplant are accepted options; treatment method is left to surgeon preference. We sought to describe different characteristics of patients with secondary hyperparathyroidism receiving surgical treatment and to compare outcomes between the two treatment strategies.
We conducted a retrospective cohort study of patients aged >18 y and on dialysis who received a parathyroidectomy (Current Procedural Terminology code = 60500) using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2008-2011). Procedures were classified as subtotal if no autotransplant was performed and total if autotransplant was performed. Descriptive statistics were performed. The primary outcome variable of interest was 30-day morbidity. Secondary outcome variables studied were operative time, postoperative length of stay (LOS), 30-day mortality, and 30-day readmission. Univariate analyses were performed.
A total of 898 patients studied; of which, 236 patients (26.4%) received a tPTX and 662 (73.7%) received a subtotal parathyroidectomy. The median age was 49 y (interquartile range [IQR]: 38, 59), and majority of patients were American Society of Anesthesiologists class III (629, 70%). Nearly half of the patients were black (447, 49.8%); blacks were more likely to receive a tPTX than whites (30.2% versus 19.9%, P = 0.01). Median operative time (133 min, IQR: 92, 160 versus 120 min, IQR: 103, 181; P < 0.01) and median LOS (4 d, IQR: 3, 7 versus 4 d, IQR: 2, 6; P < 0.01) were longer after a tPTX. There was no difference in the 30-day morbidity, mortality, or readmission rates between the two treatments.
We used a national multi-institutional data set to show that despite the high-risk patient cohort and difference in operative duration, there is no difference in the more general postoperative complication rates.
对于继发性甲状旁腺功能亢进症，最佳的手术治疗方法尚未明确。甲状旁腺次全切除术和甲状旁腺全切除术（tPTX）联合自体移植是可接受的选择；治疗方法取决于外科医生的偏好。我们旨在描述接受手术治疗的继发性甲状旁腺功能亢进症患者的不同特征，并比较两种治疗策略的结果。
我们使用美国外科医师学会国家手术质量改进计划参与者使用文件（2008-2011 年）对年龄大于 18 岁且正在接受透析治疗的接受甲状旁腺切除术（当前程序术语代码=60500）的患者进行了回顾性队列研究。如果未进行自体移植，则将手术分类为甲状旁腺次全切除术，如果进行了自体移植，则将手术分类为甲状旁腺全切除术。进行了描述性统计分析。主要研究的结果变量是 30 天发病率。研究的次要结果变量是手术时间、术后住院时间（LOS）、30 天死亡率和 30 天再入院率。进行了单变量分析。
共研究了 898 例患者；其中，236 例（26.4%）患者接受了 tPTX，662 例（73.7%）患者接受了甲状旁腺次全切除术。中位年龄为 49 岁（四分位距 [IQR]：38，59），大多数患者为美国麻醉医师协会 III 级（629 例，70%）。将近一半的患者为黑人（447 例，49.8%）；与白人相比，黑人更有可能接受 tPTX（30.2%对 19.9%，P=0.01）。tPTX 后的中位手术时间（133 分钟，IQR：92，160 分钟对 120 分钟，IQR：103，181 分钟；P<0.01）和中位 LOS（4 天，IQR：3，7 天对 4 天，IQR：2，6 天；P<0.01）更长。两种治疗方法之间的 30 天发病率、死亡率或再入院率没有差异。
我们使用全国多机构数据集表明，尽管患者队列风险较高且手术时间不同，但总体术后并发症发生率并无差异。
