Outpatient minimally invasive parathyroidectomy is safe for elderly patients.
BACKGROUND
Elderly patients with primary hyperparathyroidism (PHPT) are often not referred for surgical intervention because of concern of comorbid conditions that may increase perioperative complications. Because PHPT is more common in the elderly, we sought to compare indications and complications of minimally invasive parathyroidectomy in patients 70 years of age and older (elderly) with their younger counterparts.


METHODS
A review was conducted of a prospectively collected database of all patients undergoing parathyroidectomy on our endocrine surgery service. Data collected included patient demographic, biochemical pathologic, and operative findings. Wilcoxon rank sum and chi-square tests were used for comparisons.


RESULTS
Three hundred eighty-eight patients with PHPT recently underwent parathyroidectomy over a 3-year period (elderly, n=101; younger, n=287). The elderly cohort had significantly higher median preoperative creatinine (elderly, 2.0 mg/dL; younger,1.0 mg/dL; p=0.002) and parathyroid hormone (elderly, 145 pg/mL; younger, 123 pg/mL; p=0.026) levels. The elderly cohort also had more severe osteoporosis, with a significantly worse median bone mineral density T-score (elderly, -2.5; younger, -1.8; p<0.001). The rate of postoperative complications was similarly low in both groups (elderly, 5.9%; younger, 3.5%; p=0.38).


CONCLUSIONS
Minimally invasive parathyroidectomy for PHPT can be performed as safely in elderly patients as in their younger counterparts. Elderly patients with PHPT are more likely to have osteoporosis and higher creatinine levels at the time of surgical referral. Additional study of the role of earlier intervention is warranted.
Shin
Susanna H
SH
Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
Holmes
Holly
H
Bao
Ruijun
R
Jimenez
Camilo
C
Kee
Spencer S
SS
Potylchansky
Elena
E
Lee
Jeffrey E
JE
Evans
Douglas B
DB
Perrier
Nancy D
ND
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D055815:Young Adult