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Total versus subtotal parathyroidectomy for secondary hyperparathyroidism

Artikel i vetenskaplig tidskrift
Författare E. Isaksson
K. Ivarsson
S. Akaberi
Andreas Muth
K. G. Prutz
N. Clyne
G. Sterner
M. Almquist
Publicerad i Surgery
Volym 165
Nummer/häfte 1
Sidor 142-150
ISSN 0039-6060
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för kirurgi
Sidor 142-150
Språk en
Länkar dx.doi.org/10.1016/j.surg.2018.04.0...
Ämnesord long-term survival, mineral metabolism, dialysis patients, patient, survival, morbidity, risk, association, mortality, fracture, outcomes, Surgery, arlson me, 1987, journal of chronic diseases, v40, p373
Ämneskategorier Kirurgi

Sammanfattning

Background: It remains unclear whether total or subtotal parathyroidectomy for secondary hyperparathyroidism yields the best outcomes. We investigated mortality, cardiovascular events, hip fracture, and recurrent parathyroidectomy after total versus subtotal parathyroidectomy in patients on renal replacement therapy. Methods: Using the Swedish Renal Registry, the surgical registry for thyroid and parathyroid surgery, and the National Inpatient Registry, we identified patients who underwent parathyroidectomy between 1991 and 2013. We calculated the risk of outcome after total versus subtotal parathyroidectomy using COX's regression, adjusting for age, sex, cause of renal disease, time with a functioning graft before and after parathyroidectomy, Charlson comorbidity index, year of surgery, prevalent cardiovascular disease, time on dialysis, renal transplantation at parathyroidectomy, and treatment with calcimimetics before parathyroidectomy. Results: There were 824 patients who underwent parathyroidectomy, 388 total and 436 subtotal. There was no difference in mortality or risk of incident hip fracture between groups. Comparing the subtotal with the total parathyroidectomy, the adjusted hazard ratio (95% confidence interval) for cardiovascular events was 0.43 (0.25-0.72) and for recurrent parathyroidectomy 3.33 (1.33-8.32). Conclusion: There was a higher risk of cardiovascular events in patients after total parathyroidectomy compared with subtotal parathyroidectomy, but a lower risk of recurrent parathyroidectomy. (C) 2018 Elsevier Inc. All rights reserved.

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