title: Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia.
abstract: BACKGROUND
  With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery.
  
  
  METHODS
  Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h.
  
  
  RESULTS
  Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery.
  
  
  CONCLUSIONS
  In patients 80 years or older, minimally invasive surgery as an outpatient under local anesthesia offered an excellent risk/benefit ratio given its many advantages: simplicity, speed, absence of general anesthesia, ease of monitoring, direct voice control intraoperatively, very low morbidity, effectiveness in treating primary hyperparathyroidism in more than 95% of first intention patients, and the possibility of immediate or delayed recovery in the event of multiglandular disease going unnoticed.
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Stéphanie Li Sun
authors.initials: SL
authors.lastname: Fui
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France. Electronic address: philippe_bonnichon@yahoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bonnichon
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonni
authors.affiliation: Service de médecine nucléaire, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Delbot
authors.affiliation: Département d'anesthésie, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Jean Pascal
authors.initials: JP
authors.lastname: André
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Pion-Graff
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Berrod
authors.affiliation: IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Fontaine
authors.affiliation: Service du PMSI, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brunaud
authors.affiliation: Service du PMSI, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Cocagne
mesh_terms: D000236:Adenoma / Q000150:complications / Q000401:mortality / Q000601:surgery; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000772:Anesthesia, Local; D000075202:Contraindications; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D010282:Parathyroid Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Chirurgie ambulatoire; Chirurgie mini-invasive; Hyperparathyroïdie primaire; Non invasive surgery; Outpatient surgery; Parathyroidectomy under local anesthesia; Parathyroids; Parathyroïdectomie anesthésie locale; Parathyroïdes; Primary hyperparathyroidism