Parathyroidectomy in the elderly: analysis of 7313 patients.

BACKGROUND

The elderly are the fastest growing subset of the U.S. population, and suffer most from primary hyperparathyroidism. This is the first multi-institutional study to characterize 30-d outcomes in elderly patients undergoing parathyroidectomy.

MATERIALS AND METHODS

Patients who underwent parathyroidectomy for primary hyperparathyroidism in ACS-NSQIP, 2005-8, were stratified into age groups: 45-64, 65-79, and ≥80 y. Independent patient variables included gender, race, inpatient/outpatient type, anesthesia, ASA classification, functional status, and presence/absence of >30 conditions. Outcomes included overall/system-specific complications, return to the OR, operating times, LOS, 30-d mortality. Patients 65-79 and ≥80 y were compared with younger ones using multivariable linear and logistic regression.

RESULTS

A total of 7313 patients were identified: 77.8% women, 77.2% White, and 95.6% underwent first-time parathyroidectomy. Patients 65-79 and ≥ 80 y were more likely to have inpatient parathyroidectomies compared with younger patients (42.4%, 46.8% versus 36.0%) and higher ASA classification (42.4%, 59.8% versus 24.2%, all P 0.01). Patients ≥ 80 y were less likely than those 45-64 y to receive general anesthesia (84.9% versus 89.8%, P 0.01). Patients ≥ 65 y were more likely to have ≥1 complication (2.2% versus 1.3%, P 0.01) and respiratory-specific complications compared with younger patients (0.9% versus 0.3%, P 0.01). Patients 65-79 and ≥80 y were more likely to have extended hospital stays (7.7%, 12.2% versus 6.5%, P 0.01); mortality rate for patients ≥ 80 y was higher (0.8% versus 0.1%, P 0.01). On multivariable analysis, patients ≥ 65 y had increased risks for overall/respiratory complications and extended hospital stays, (all P 0.01).

CONCLUSIONS

Elderly patients sustain more morbidity following parathyroidectomy. Advanced age may be an independent risk factor worth considering in surgical decision-making.