Rates and Outcomes of Parathyroidectomy for Secondary Hyperparathyroidism in the United States.
Secondary hyperparathyroidism is common among patients with ESRD. Although medical therapy for secondary hyperparathyroidism has changed dramatically over the last decade, rates of parathyroidectomy for secondary hyperparathyroidism across the United States population are unknown. We examined temporal trends in rates of parathyroidectomy, in-hospital mortality, length of hospital stay, and costs of hospitalization.



Using the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, a representative national database on hospital stay regardless of age and payer in the United States, we identified parathyroidectomies for secondary hyperparathyroidism from 2002 to 2011. Data from the US Renal Data System reports were used to calculate the rate of parathyroidectomy.



We identified 32,971 parathyroidectomies for secondary hyperparathyroidism between 2002 and 2011. The overall rate of parathyroidectomy was approximately 5.4/1000 patients (95% confidence interval [95% CI], 5.0/1000 to 6.0/1000). The rate decreased from 2003 (7.9/1000 patients; 95% CI, 6.2/1000 to 9.6/1000), reached a nadir in 2005 (3.3/1000 patients; 95% CI, 2.6/1000 to 4.0/1000), increased again through 2006 (5.4/1000 patients; 95% CI, 4.4/1000 to 6.4/1000), and remained stable since that time. Rates of in-hospital mortality decreased from 1.7% (95% CI, 0.8% to 2.6%) in 2002 to 0.8% (95% CI, 0.1% to 1.6%) in 2011 (P for trend <0.001). In-hospital mortality rates were significantly higher in patients with heart failure (odds ratio [OR], 4.23; 95% CI, 2.59 to 6.91) and peripheral vascular disease (OR, 4.59; 95% CI, 2.75 to 7.65) and lower among patients with prior kidney transplantation (OR, 0.20; 95% CI, 0.06 to 0.65).



Despite the use of multiple medical therapies, rates of parathyroidectomy of secondary hyperparathyroidism have not declined in recent years.
Division of Nephrology, Department of Medicine.
Sun Moon
SM
Kim
Division of Nephrology, Department of Medicine.|Division of Pediatric Nephrology, Department of Pediatrics, and.
Jin
J
Long
Division of Nephrology, Department of Medicine.
Maria E
ME
Montez-Rath
Division of Nephrology, Department of Medicine.|Division of Pediatric Nephrology, Department of Pediatrics, and.
Mary B
MB
Leonard
Department of Surgery, Stanford University School of Medicine, Palo Alto, California.
Jeffrey A
JA
Norton
Division of Nephrology, Department of Medicine.
Glenn M
GM
Chertow
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D000069449:Cinacalcet; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000706:statistics & numerical data* / Q000639:trends; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000069449:Cinacalcet
Chronic; Hospital Mortality; Humans; Hyperparathyroidism; Kidney Failure; Length of Stay; Nationwide Inpatient Sample; Secondary; health services research; hospitalization; hyperparathyroidism; parathyroidectomy