Less Is More: Parathyroidectomy and Association with Postoperative Hypocalcemia in Dialysis Patients

Area of Science:

• Endocrinology
• Nephrology
• Surgical Oncology

Background:

• Secondary hyperparathyroidism (SHPT) is a common complication in dialysis patients.
• Parathyroidectomy (PTx) is an effective treatment for SHPT, but surgical approaches vary.
• Limited literature exists on the impact of different PTx techniques on postoperative hypocalcemia.

Purpose of the Study:

• To compare the incidence of postoperative hypocalcemia between subtotal PTx and total PTx with autotransplantation in SHPT patients.
• To evaluate the association of surgical approach with hypocalcemia adverse events, length of stay, and calcium requirements.

Main Methods:

• Retrospective review of 143 dialysis patients who underwent PTx between 2010 and 2021.
• Definition of hypocalcemia adverse events included intravenous calcium requirement or 30-day readmission.
• Comparison of outcomes including length of stay, oral calcium needs, and surgical success between subtotal PTx and total PTx with autotransplantation groups.

Main Results:

• Subtotal PTx (n=24) was associated with significantly fewer hypocalcemia adverse events (8.3% vs. 47.1%) compared to total PTx with autotransplantation (n=119).
• Patients undergoing subtotal PTx had a shorter length of stay and lower 1-month oral calcium requirements.
• Multivariable analysis confirmed total PTx with autotransplantation increased the likelihood of hypocalcemia adverse events (aOR 11.9).

Conclusions:

• Subtotal parathyroidectomy is linked to reduced postoperative hypocalcemia in dialysis patients with SHPT.
• Both subtotal and total PTx with autotransplantation achieve similar surgical cure rates for SHPT.
• Subtotal PTx may be a preferred surgical strategy to mitigate hypocalcemia complications.