Parathyroidectomy in dialysis patients

What is the risk?

Jamie Anderson, Jennifer L. Olson, Michael Campbell

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim: Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population. Materials and methods: We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures. Results: A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5%) were on dialysis. Among patients under going parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4% vs 0.1%, p < 0.001; 7.9% vs 1.4%, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035). Conclusion: Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients. Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments.

Original languageEnglish (US)
Pages (from-to)189-193
Number of pages5
JournalWorld Journal of Endocrine Surgery
Volume8
Issue number3
DOIs
StatePublished - Sep 1 2016

Fingerprint

Parathyroidectomy
Dialysis
Arteriovenous Fistula
Mortality
Odds Ratio
Hyperparathyroidism
Quality Improvement
Informed Consent
Chronic Renal Insufficiency

Keywords

  • Dialysis
  • Hyperparathyroidism
  • National surgical quality improvement program
  • Parathyroidectomy
  • Secondary hyperparathyroidism
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Radiology Nuclear Medicine and imaging

Cite this

Parathyroidectomy in dialysis patients : What is the risk? / Anderson, Jamie; Olson, Jennifer L.; Campbell, Michael.

In: World Journal of Endocrine Surgery, Vol. 8, No. 3, 01.09.2016, p. 189-193.

Research output: Contribution to journalArticle

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title = "Parathyroidectomy in dialysis patients: What is the risk?",
abstract = "Aim: Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population. Materials and methods: We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures. Results: A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5{\%}) were on dialysis. Among patients under going parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4{\%} vs 0.1{\%}, p < 0.001; 7.9{\%} vs 1.4{\%}, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035). Conclusion: Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients. Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments.",
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N2 - Aim: Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population. Materials and methods: We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures. Results: A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5%) were on dialysis. Among patients under going parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4% vs 0.1%, p < 0.001; 7.9% vs 1.4%, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035). Conclusion: Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients. Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments.

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