Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2021 Aug;264:444-453. doi: 10.1016/j.jss.2021.03.013. Epub 2021 Apr 10.
Secondary hyperparathyroidism (SHPT) commonly occurs in end-stage renal disease (ESRD), leading to vascular calcification and increased mortality. For SHPT refractory to medical management, parathyroidectomy improves symptoms and decreases mortality. Medical management has changed with the release of new guidelines and advent of novel medications. We investigate recent national trends in parathyroidectomy for SHPT.
We used the National/Nationwide Inpatient Sample from 2004 to 2016 to identify hospitalizations including parathyroidectomy for SHPT and calculated parathyroidectomy rates utilizing data from the United States Renal Data System. Subgroup analysis was conducted by race. Risk factors for in-hospital mortality were identified with purposeful selection and multivariable logistic regression.
From 2004 to 2016, the rate of parathyroidectomies for SHPT per 1000 ESRD patients decreased from 6.07 (95% CI: 4.83-7.32) to 3.67 (95% CI: 3.33-4.00). Black patients underwent parathyroidectomy for SHPT at a 1.8-fold higher rate than white and Hispanic patients (5.59 versus 3.04 and 3.07). Almost all tracked comorbidities increased in prevalence. In-hospital mortality trended lower (1.5% to 0.8%, P = 0.051). Risk factors for in-hospital mortality included weight loss (OR 4.19, 95% CI: 2.00-8.78) and cardiac arrhythmia (OR 3.38, 95% CI: 1.66-6.91), while additional calendar year (OR = 0.87, 95% CI: 0.80-0.95) was protective.
The etiology of the declining parathyroidectomy rate for SHPT is unclear; possible factors include changing guidelines emphasizing medical management, widespread availability of cinacalcet, changing practice patterns, and inadequate surgical referral.
继发性甲状旁腺功能亢进症（SHPT）在终末期肾病（ESRD）中很常见，可导致血管钙化和死亡率增加。对于药物治疗无效的 SHPT，甲状旁腺切除术可改善症状并降低死亡率。随着新指南的发布和新型药物的出现，药物治疗发生了变化。我们研究了最近全国范围内针对 SHPT 的甲状旁腺切除术趋势。
我们使用 2004 年至 2016 年的全国/全国住院患者样本，确定了包括甲状旁腺切除术治疗 SHPT 的住院治疗，并利用美国肾脏数据系统的数据计算了甲状旁腺切除术的发生率。按种族进行亚组分析。通过有目的的选择和多变量逻辑回归确定住院死亡率的危险因素。
从 2004 年到 2016 年，每 1000 例 ESRD 患者中甲状旁腺切除术治疗 SHPT 的比例从 6.07（95%CI：4.83-7.32）降至 3.67（95%CI：3.33-4.00）。黑人患者接受甲状旁腺切除术治疗 SHPT 的比例是白人患者的 1.8 倍，是西班牙裔患者的 1.8 倍（5.59 比 3.04 和 3.07）。几乎所有追踪到的合并症的患病率都有所增加。住院死亡率呈下降趋势（1.5%降至 0.8%，P=0.051）。住院死亡率的危险因素包括体重减轻（OR 4.19，95%CI：2.00-8.78）和心律失常（OR 3.38，95%CI：1.66-6.91），而随着时间推移（OR=0.87，95%CI：0.80-0.95）的保护作用。
SHPT 甲状旁腺切除术率下降的原因尚不清楚；可能的因素包括不断变化的指南强调药物治疗、西那卡塞的广泛应用、治疗模式的变化以及手术转诊不足。
