WIEDERSEHN L1, ZAHOROWSKI B1, HASSAN H4, PRADHAN S3, PETRUCCI R2, PREDA T2, WONG J1
1Department of Renal Medicine Liverpool Hospital, Liverpool, Australia, 2Department of Surgery Liverpool Hospital, Liverpool, Australia, 3Department of Breast, Endocrine, Head and Neck Surgery Liverpool Hospital, Liverpool, Australia, 4Department of Renal Medicine The Wollongong Hospital, Wollongong, Australia
Aim: To compare outcomes between parathyroidectomies performed for primary parathyroid disease (pPTX) and those performed for renal hyperparathyroidism (rPTX) in a single centre.
Background: Despite advances in the management of mineral-bone disorders of Chronic Kidney Disease (CKD-MBD), there remains a subset of patients who require rPTX. This cohort compete for resources with patients requiring pPTX. These two cohorts represent different perioperative risk profiles. Their outcomes have not been previously directly compared.
Methods: We conducted a retrospective study of 312 patients (87 rPTX and 225 pPTX) who underwent parathyroidectomy from January 2013 to May 2020. Preoperative and postoperative variables were analysed with SPSS Statistics 188.8.131.527.
Results: The rPTX group had significantly higher APACHE III scores (validated prediction tool for ICU mortality) with a mean score of 51 compared to 31 (p <0.001). The majority of rPTX had all four glands removed (80%) whereas 80% of pPTX had only one gland removed. This resulted in longer procedure times; mean duration 165min for rPTX and 97min for pPTX (p <0.001), and in significantly lower 24hr post-operative Parathyroid Hormone (PTH) and Corrected Ca (cCa) levels. Ultimately resulting in shorter total duration of admission (median 1 day for pPTX, and 6 days for rPTX group, p <0.001). Despite this, waiting times for the rPTX and pPTX groups were not different, median days from RFA provision being 137 and 138 days for rPTX and pPTX respectively.
Conclusions: This is the first study to compare peri-operative outcomes in rPTX and pPTX cohorts. We have demonstrated that rPTX patients are more resource-intensive with longer operations and duration of post-operative stay however this did not translate to increased surgical waiting time.
Lachlan Wiedersehn is a final year nephrology advanced trainee. Lachlan has a background in product design and biomedical engineering. He is interested in general nephrology with special interest in peritoneal dialysis and metabolic bone disease in chronic kidney disease. He hopes to use his medical training and design skills to enhance patient care.