Risk factors for adverse outcomes in first-time renal parathyroid surgery: an analysis of the United Kingdom Registry of Endocrine and Thyroid Surgeons.

BACKGROUND

Recommendations for surgery in patients with renal hyperparathyroidism lack evidence. This study analysed outcomes of first-time renal parathyroidectomy in United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to establish risk factors for adverse outcomes.

METHODS

Data from 2005 to 2020 was analysed. Entries with missing data, age <15 and >85 years, and length of stay (LOS) >28 days were excluded. Outcome variables included temporary hypocalcaemia, persistent disease, re-operation for bleeding, general complications, readmission and LOS. Persistent disease was only analysed in tertiary hyperparathyroidism. Four gland excision was categorised as total, 3.5 subtotal and <3.5 less than subtotal (LTST).

RESULTS

2135 patients underwent first-time surgery, 67.6% (1443/2477) were analysed, 54.0% (779) total, 18.4% (266) sub-total 27.6% (398) LTST. Temporary hypocalcaemia occurred in 47.5% (685/1443), reoperation for bleeding 0.5% (9/1443), complications 5.6% (81/1443), readmission 2.6% (37/1443), and mean LOS 3.5 days. Temporary hypocalcaemia 59.2% (461/779, p < 0.001) and complications 6.8% (53/779, P = 0.033) were significantly higher in total parathyroidectomy. Multivariable analysis showed LTST (OR 0.317 95% CI 0.243-0.415 p < 0.001), increasing age (OR 0.985 95% CI 0.977-0.992 p < 0.001), imaging (OR 0.632 95% CI 0.494-0.809 p < 0.001), and tertiary hyperparathyroism (OR 0.789 95% CI 0.628-0.991 p = 0.042) significantly decreased the risk of temporary hypocalcaemia. Persistent disease occurred in 4.9% (28/576) of patients with tertiary hyperparathyroidism. Multivariable analysis found this was significantly higher (OR 5.35 95% CI 2.253-12.703 p < 0.001) in LTST.

CONCLUSIONS

Total parathyroidectomy was the commonest operation. The incidence of temporary hypocalcaemia was high, and although this was reduced in LTST, this operation was associated with an unacceptably high incidence of persistent disease in tertiary hyperparathyroidism.