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Mortality after surgery for primary hyperparathyroidism: results from a nationwide cohort
M Nilsson1,2, K Ivarsson2,3, M Thier1,2
1Department of Surgery, Skåne University Hospital, Lund, Sweden.
Insights
Contemporary patients with primary hyperparathyroidism (PHP) do not have increased mortality after surgery compared to the general population. However, higher preoperative serum calcium levels in PHP patients may be linked to increased mortality risk.
Area of Science:
- Endocrinology
- Surgical Outcomes
- Public Health
Background:
- Primary hyperparathyroidism (PHP) often presents with mildly elevated serum calcium.
- Previous research indicated higher mortality rates in PHP patients.
- Contemporary data on PHP patient mortality compared to the general population is limited.
Purpose of the Study:
- To investigate if contemporary patients operated for primary hyperparathyroidism (PHP) exhibit higher mortality than the general population.
- To determine the association between mortality in PHP patients and preoperative serum calcium concentration, adenoma weight, and multiglandular disease.
Main Methods:
- Retrospective cohort study using a Swedish national register (2003-2013).
- Matching PHP patients with population controls and cross-linking with national registers for mortality and socioeconomic data.
- Analysis using standardized mortality ratio, Kaplan-Meier estimates, and Cox regression, with multiple imputation for missing data.
Main Results:
- The study included 5009 PHP patients and 14,983 controls.
- Adjusted Cox regression revealed lower mortality in operated PHP patients compared to controls (HR 0.83).
- Preoperative serum calcium concentration was associated with increased mortality in PHP patients (multivariable HR 1.79).
Conclusions:
- Surgery for primary hyperparathyroidism (PHP) in a contemporary setting is not associated with increased mortality compared to the general population.
- Elevated preoperative serum calcium levels in PHP patients may be a significant factor influencing survival.
- Further research into the impact of preoperative calcium levels on PHP patient outcomes is warranted.
Background:
Contemporary patients with primary hyperparathyroidism are often diagnosed with mildly raised serum calcium levels. Previous studies have reported increased mortality in patients with primary hyperparathyroidism. This retrospective cohort study aimed to examine whether contemporary patients operated for primary hyperparathyroidism have higher mortality than the general population, and whether mortality in these patients is associated with serum calcium concentration, adenoma weight or multiglandular disease.
Methods:
Patients from a Swedish national cohort consisting of patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery 2003-2013, were matched with population controls. The National Patient Register, the Swedish Cause of Death Register, and socioeconomic data were cross-linked. End of follow-up was 10 years after surgery, 31 December 2015, or emigration. Mortality was analysed by standardized mortality ratio, Kaplan-Meier survival estimates, and univariable and multivariable Cox regression. Multiple imputation by chained equations was performed on missing data.
Results:
After exclusions, there were 5009 patients with primary hyperparathyroidism and 14 983 controls. Multivariable Cox regression analysis adjusted for age, sex, Charlson Co-morbidity Index, marital status, level of education, disposable income, and period of surgery showed lower mortality in patients than controls (hazard ratio (HR) 0.83, 95 per cent c.i. 0.75 to 0.92). In univariable Cox regression of mortality in patients, serum calcium concentration (mmoles per litre) was associated with mortality (HR 2.20, 1.53 to 3.16). This association remained in multivariable Cox regression after multiple imputation (HR 1.79, 1.19 to 2.70).
Conclusion:
Mortality was not increased in patients operated for primary hyperparathyroidism compared with controls in a contemporary setting. Preoperative serum calcium concentration might, however, influence survival.
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