Annals of the Royal College of Surgeons of England · 2026
Renal hyperparathyroidism: comparative outcomes of parathyroidectomy in two regional centres over 14 years.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Michael S, Matias N, Alwani O, Matkin W, Solomon E, Lively A, Ricardo D, Ahmed M, Moinuddin Z, Augustine T, Chinnadurai R, Doran H
Аннотация
INTRODUCTION: Renal hyperparathyroidism is a common complication of chronic kidney disease, often requiring parathyroidectomy (PTX) when medical therapy fails. Following surgical intervention, recurrence and postoperative complications, in particular hypocalcaemia, are variable. This study compares post-PTX outcomes between two UK centres, focusing on recurrence rates, length of stay (LOS) and factors influencing postoperative intravenous (IV) calcium administration.
METHODS: A retrospective cohort study was conducted across two centres from 2008-2022. Demographic, biochemical, and clinical factors were analysed, with primary outcomes being disease recurrence and postoperative IV calcium requirement.
RESULTS: In total, 114 patients were included: 66 from centre A and 48 from centre B. Some 65.2% underwent total parathyroidectomy in centre A vs 60.4% in centre B. The remainder were subtotal parathyroidectomies. Total recurrence was higher in centre A (34.8%) than centre B (20.8%) and a longer LOS was seen in centre A (median 5.5 days vs 3 days, p = 0.007). IV calcium use was higher in centre B (35.4% vs 24.2%, p = 0.194), although not statistically significant. Predictors of recurrence were limited, with preloading with alfacalcidol being protective in a univariate model (hazard ratio [HR] 0.33, p = 0.005). Higher postoperative phosphate, parathyroid hormone and alkaline phosphate levels were significant predictors of postoperative IV calcium in multivariate analysis (p < 0.05).
CONCLUSIONS: Significant differences in recurrence and LOS suggest that preoperative disease burden and perioperative management strategies influence outcomes. The higher recurrence at centre A may be linked to disease severity, while the shorter LOS and higher IV calcium use at centre B may reflect different pre- and postoperative care approaches. These findings highlight the need for careful management and identification of factors which may impact outcomes.
METHODS: A retrospective cohort study was conducted across two centres from 2008-2022. Demographic, biochemical, and clinical factors were analysed, with primary outcomes being disease recurrence and postoperative IV calcium requirement.
RESULTS: In total, 114 patients were included: 66 from centre A and 48 from centre B. Some 65.2% underwent total parathyroidectomy in centre A vs 60.4% in centre B. The remainder were subtotal parathyroidectomies. Total recurrence was higher in centre A (34.8%) than centre B (20.8%) and a longer LOS was seen in centre A (median 5.5 days vs 3 days, p = 0.007). IV calcium use was higher in centre B (35.4% vs 24.2%, p = 0.194), although not statistically significant. Predictors of recurrence were limited, with preloading with alfacalcidol being protective in a univariate model (hazard ratio [HR] 0.33, p = 0.005). Higher postoperative phosphate, parathyroid hormone and alkaline phosphate levels were significant predictors of postoperative IV calcium in multivariate analysis (p < 0.05).
CONCLUSIONS: Significant differences in recurrence and LOS suggest that preoperative disease burden and perioperative management strategies influence outcomes. The higher recurrence at centre A may be linked to disease severity, while the shorter LOS and higher IV calcium use at centre B may reflect different pre- and postoperative care approaches. These findings highlight the need for careful management and identification of factors which may impact outcomes.