Review of a prospective clinical database of patients undergoing surgical evaluation and management of primary hyperparathyroidism was performed. This included all parathyroidectomies performed from May 1998 until June 2007.
Data collected included age; gender; pre-operative and postoperative calcium levels; preoperative PTH levels; length of hospital stay; length of surgery; length of post anesthesia care unit (PACU) stay; history of previous neck surgery; history, extent, and findings upon neck exploration; and type and timing of complications.
Conclusions
Parathyroidectomy is a commonly performed procedure at our institution, with nearly 450 patients younger than 65 years and 250 patients older than 65 years undergoing this surgery over a decade. The majority of affected patients are female, with approximately one-third of patients being older than 65 years of age.
In this study, outcome following parathyroidectomy was good, with postoperative normocalcemia in >80% of patients, regardless of age. Elderly patients were more likely to have normocalcemia with persistently elevated PTH levels postoperatively, with higher abnormal PTH levels preoperatively. While this difference is not quite statistically significant, it is important to keep in mind when managing the elderly postoperative parathyroidectomy patient. Future studies are warranted to clarify this issue further. Increasingly, hypovitaminosis D is implicated in patients with postoperative normocalcemia with persistently elevated PTH. This study may indicate an increased incidence of or susceptibility to hypovitaminosis D in patients older than 65 years compared to younger patients, but requires additional investigation. Elderly patients do tend to have longer lengths of hospital and PACU stay; however, their surgery time is not increased.
Importantly, elderly patients do not have an increased risk of complications, displaying rates of both minor and major complications essentially equivalent to the younger age group in this study. This finding is consistent with other reports in the literature, which describe parathyroidectomy in such patients to be safe, well tolerated, and effective. Notably, however, elderly patients are still more likely to have systemic cardiac complications than younger patients, warranting careful screening and observation. Nevertheless, when properly indicated, parathyroidectomy remains a safe and effective option for elderly patients with primary hyperparathyroidism.