title: Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis.
abstract: BACKGROUND
  Secondary hyperparathyroidism (SHPT) is associated with adverse outcomes in patients receiving maintenance dialysis. Parathyroidectomy is a treatment for SHPT; whether parathyroidectomy utilization varies geographically in the US is unknown.
  
  
  METHODS
  A retrospective cohort analysis was undertaken to identify all patients aged 18 years or older who were receiving in-center hemodialysis between 2007 and 2009, were covered by Medicare Parts A and B, and had been receiving hemodialysis for at least 1 year. Parathyroidectomy was identified from inpatient claims using relevant International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Patient characteristics and End-Stage Renal Disease Network (a proxy for geography) were ascertained. Adjusted odds ratios for parathyroidectomy were estimated from a logistic model.
  
  
  RESULTS
  A total of 286,569 patients satisfied inclusion criteria, of whom 4435 (1.5%) underwent PTX. After adjustment for a variety of patient characteristics, there was a 2-fold difference in adjusted odds of parathyroidectomy between the most- and least-frequently performing regions. Adjusted odds ratios were more than 20% higher than average in four networks, and more than 20% lower in four networks.
  
  
  CONCLUSIONS
  Parathyroidectomy use varies substantially by geography in the US; the factors responsible should be further investigated.
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, Minneapolis, MN, 55404, USA. James.Wetmore@hcmed.org.|Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA. James.Wetmore@hcmed.org.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA. James.Wetmore@hcmed.org.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, Minneapolis, MN, 55404, USA.
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.affiliation: Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Dluzniewski
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, Minneapolis, MN, 55404, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.|Section of Renal Diseases and Hypertension, Minneapolis Veterans Administration Health Care System, Minneapolis, MN, USA.
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.affiliation: Denver Nephrology Clinical Research Division, Denver, CO, USA.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Block
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, Minneapolis, MN, 55404, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Dialysis; End-stage renal disease; Mineral metabolism; Parathyroidectomy; Secondary hyperparathyroidism