Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, TX; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
Surgery. 2020 Nov;168(5):838-844. doi: 10.1016/j.surg.2020.05.018. Epub 2020 Jul 19.
Primary hyperparathyroidism is underdiagnosed and undertreated nationally despite the benefits of parathyroidectomy. However, the degree of hospital-level variation in the management of primary hyperparathyroidism is unknown.
We performed a national, retrospective study of Veterans with primary hyperparathyroidism using the Veterans Affairs Corporate Data Warehouse from January 2000 to September 2015. The objective was to characterize the extent of hospital-level variation in the use of parathyroidectomy for the management of primary hyperparathyroidism within a national, integrated healthcare system. Rate of parathyroidectomy in patients with primary hyperparathyroidism was stratified by (1) geographic region, (2) facility complexity level, (3) volume of parathyroidectomies per facility, and (4) frequency of parathyroid hormone testing in hypercalcemic patients.
Among 47,158 Veterans with primary hyperparathyroidism, 6,048 (12.8%) underwent parathyroidectomy. Rates of parathyroidectomy were significantly higher in the Continental (17.0%) and Pacific (16.0%) regions than in other areas (11.4%, P < .01). The highest complexity referral centers had the highest rate of parathyroidectomy (13.6%) compared with all other facilities (12.1%, P < .01). Centers that performed the highest volume of parathyroidectomies were more likely to offer surgery (13.3%) than low volume centers (8.9%, P < .01). Facilities with higher frequency of parathyroid hormone testing among hypercalcemic patients were more likely to offer parathyroidectomy (15.2%) than those with the lowest parathyroid hormone testing frequency (12.6%, P < .01).
Although there is notable variation in parathyroidectomy use for definitive treatment of primary hyperparathyroidism between Veterans Affairs facilities, parathyroidectomy rates are low across the entire system. Further research is needed to understand additional local contextual and other patient and clinician-level factors for the undertreatment of primary hyperparathyroidism to subsequently guide corrective interventions.
尽管甲状旁腺切除术有诸多益处，但在全国范围内，原发性甲状旁腺功能亢进症仍未得到充分诊断和治疗。然而，医院层面在原发性甲状旁腺功能亢进症管理方面的差异程度尚不清楚。
我们利用退伍军人事务部企业数据仓库，对 2000 年 1 月至 2015 年 9 月期间患有原发性甲状旁腺功能亢进症的退伍军人进行了一项全国性的回顾性研究。本研究的目的是描述在全国性的综合性医疗体系中，医院层面在原发性甲状旁腺功能亢进症的甲状旁腺切除术应用方面的差异程度。根据（1）地理位置、（2）医疗机构复杂程度级别、（3）每个医疗机构的甲状旁腺切除术量、（4）高钙血症患者甲状旁腺激素检测频率，对原发性甲状旁腺功能亢进症患者的甲状旁腺切除术率进行分层。
在 47158 例患有原发性甲状旁腺功能亢进症的退伍军人中，有 6048 例（12.8%）接受了甲状旁腺切除术。与其他地区（11.4%，P<.01）相比，大陆地区（17.0%）和太平洋地区（16.0%）的甲状旁腺切除术率明显更高。最高复杂程度转诊中心的甲状旁腺切除术率最高（13.6%），而所有其他医疗机构的甲状旁腺切除术率为 12.1%（P<.01）。进行甲状旁腺切除术数量最高的中心更有可能进行手术（13.3%），而进行甲状旁腺切除术数量较低的中心（8.9%）则较少进行手术（P<.01）。高钙血症患者中甲状旁腺激素检测频率较高的医疗机构更有可能进行甲状旁腺切除术（15.2%），而甲状旁腺激素检测频率最低的医疗机构则较少进行甲状旁腺切除术（12.6%）（P<.01）。
尽管退伍军人事务部医疗机构之间在甲状旁腺切除术用于原发性甲状旁腺功能亢进症的确定性治疗方面存在显著差异，但整个系统中的甲状旁腺切除术率仍然较低。需要进一步研究，以了解原发性甲状旁腺功能亢进症治疗不足的其他局部背景以及其他患者和临床医生层面的因素，以便随后指导采取纠正干预措施。
