title: Two hundred and two consecutive operations for secondary hyperparathyroidism: has medical management changed the profiles of patients requiring parathyroidectomy?
abstract: BACKGROUND
  Because of improvements in the medical management of end-stage renal disease, some surgeons perceive that they now perform fewer operations for secondary hyperparathyroidism, and that current patients have more advanced disease.
  
  
  METHODS
  One hundred and seventy-two patients undergoing 202 operations for secondary hyperparathyroidism between 1988 and 2007 were reviewed. Patients operated on in the past decade (1998-2007) were compared with those from the previous decade (1988-1997). The main outcome measures were pre- and post-operative biochemical and symptom profiles, operation performed, and recurrence.
  
  
  RESULTS
  One hundred and thirty first-time operations and 72 reoperations were performed. From 1988 to 1997, 106 operations were performed, compared with 96 from 1998 to 2007. There were no demographic differences between decades. There were no differences in preoperative serum calcium (10.0 mg/dL vs 10.2 mg/dL), PTH (1622 ng/L vs 1424 ng/L), phosphate (6.9 mg/dL vs 7.0 dL), and alkaline phosphatase (339 U/L vs 347 U/L). Symptom profiles were similar. Patients in the past decade were less likely to require reoperation (6% vs 22%) (P < .05).
  
  
  CONCLUSIONS
  Despite improvements in medical management, the population of patients requiring parathyroidectomy for secondary hyperparathyroidism has remained constant in number and preoperative biochemical and symptom profiles over the past 2 decades. However, fewer patients have required reoperation in the past decade.
authors.affiliation: Department of Surgery, University of California, San Francisco, CA 94115, USA. Wen.Shen@ucsfmedctr.org
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects; D012086:Reoperation