Document Detail


Parathyroidectomy in the elderly: do the benefits outweigh the risks?
MedLine Citation:
PMID:  9597924     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although the incidence of hyperparathyroidism (HPT) in the elderly exceeds 1.5%, limited resources and co-morbidity inhibit referral for parathyroidectomy. To determine the risks and benefits of surgery, we examined the outcomes of elderly patients who underwent exploration for primary HPT. Data from 211 consecutive patients who underwent parathyroidectomy by one surgeon at the Johns Hopkins Hospital between August 1990 and May 1996 were recorded prospectively. Of these patients, 184 had primary HPT. Demographic and outcome data of elderly patients (> 70 years of age) (n = 36) were compared to those from younger patients (< 70 years of age) (n = 148). Preoperative symptoms of mental impairment, bone disease, and fatigue were more common in elderly patients (p < 0.05), and nephrolithiasis was more frequent in younger patients (p < 0.025). Elderly patients presented with more advanced disease, manifested by higher preoperative parathyroid hormone levels (301.9 +/- 63.3 vs. 169.2 +/- 14.3 pg/ml, p < 0.05). The cure rate (94.4%), morbidity (5.5%), and mortality (0%) in the elderly were indistinguishable from those of their younger cohorts (98%, 1.4%, and 0%, respectively). In conclusion, the more advanced disease seen in the elderly suggests that they are referred for surgery with a higher threshold than younger patients. Although several series of parathyroidectomy in elderly patients have reported high morbidity rates, significant mortality, and long length of stay (LOS), we found that parathyroidectomy in these patients can be performed with high cures, low morbidity, no mortality, short LOS, and high patient satisfaction. These data suggest that the benefits of surgery outweigh its risks and argue for a lower threshold for referral of elderly patients with primary HPT for surgical treatment.
Authors:
H Chen; S Parkerson; R Udelsman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  22     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1998-06-30     Completed Date:  1998-06-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  531-5; discussion 535-6     Citation Subset:  IM    
Affiliation:
Division of Endocrine and Oncologic Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Female
Humans
Hyperparathyroidism / complications,  surgery*
Male
Middle Aged
Parathyroidectomy* / adverse effects
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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