Darci C Foote, Xue Zhao, Bin You, Joy Z Done, Jennine Weller, Rachel Stemme, Natalie Moreno, Lilah F Morris-Wiseman, Aarti Mathur
{"title":"Surgical outcomes of parathyroidectomy for pre-kidney transplantation versus post-kidney transplantation patients.","authors":"Darci C Foote, Xue Zhao, Bin You, Joy Z Done, Jennine Weller, Rachel Stemme, Natalie Moreno, Lilah F Morris-Wiseman, Aarti Mathur","doi":"10.1002/wjs.12468","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hyperparathyroidism (HPT) is common in end-stage kidney disease and resolves in less than half of kidney transplant (KT) recipients. The ideal timing of parathyroidectomy (PTX), before or after KT, remains unclear. We sought to understand differences in morbidity and mortality after PTX pre-KT and post-KT.</p><p><strong>Methods: </strong>We identified adult patients who underwent PTX pre-KT or post-KT between 2012 and 2021 utilizing the National Surgical Quality Improvement Program database. Demographics, clinical characteristics, morbidity, and mortality were compared. Adjusted logistic regression with propensity score weighting assessed odds of 30-day composite morbidity, major adverse cardiovascular events (MACE), readmission, and mortality.</p><p><strong>Results: </strong>We identified 1972 patients who underwent PTX pre-KT and 541 patients who underwent PTX post-KT. Post-KT HPT patients were older (mean age 53.9 v 48.2 and p < 0.01) and more commonly White (45.3% v 32.3% and p < 0.01) and diabetic (30.0% v 18.5% and p < 0.01). In comparison, pre-KT HPT patients were more commonly Black (53.2% v 30.1%), had American Society of Anesthesiologists (ASA) class 3-4 (98.0% v 89.6% and p < 0.01), chronic obstructive pulmonary disease (4.2% v 1.5% and p < 0.01), and congestive heart failure (4.4% v 1.1% and p < 0.01). After adjusting for confounders, patients pre-KT had 1.72-fold increased odds of morbidity (95% confidence interval [CI]: 1.13-2.61), 8.39-fold increased odds of MACE (95% CI: 1.13-62.18), and 2.07-fold increased odds of readmission (95% CI: 1.38-3.10). There was no difference in mortality or risk of infections.</p><p><strong>Conclusions: </strong>Patients who underwent PTX prior to KT were at significantly increased risk for 30-day morbidity and MACE, but no different odds of mortality compared to PTX after KT. This can help inform decision-making regarding timing of PTX in patients with HPT.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/wjs.12468","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hyperparathyroidism (HPT) is common in end-stage kidney disease and resolves in less than half of kidney transplant (KT) recipients. The ideal timing of parathyroidectomy (PTX), before or after KT, remains unclear. We sought to understand differences in morbidity and mortality after PTX pre-KT and post-KT.
Methods: We identified adult patients who underwent PTX pre-KT or post-KT between 2012 and 2021 utilizing the National Surgical Quality Improvement Program database. Demographics, clinical characteristics, morbidity, and mortality were compared. Adjusted logistic regression with propensity score weighting assessed odds of 30-day composite morbidity, major adverse cardiovascular events (MACE), readmission, and mortality.
Results: We identified 1972 patients who underwent PTX pre-KT and 541 patients who underwent PTX post-KT. Post-KT HPT patients were older (mean age 53.9 v 48.2 and p < 0.01) and more commonly White (45.3% v 32.3% and p < 0.01) and diabetic (30.0% v 18.5% and p < 0.01). In comparison, pre-KT HPT patients were more commonly Black (53.2% v 30.1%), had American Society of Anesthesiologists (ASA) class 3-4 (98.0% v 89.6% and p < 0.01), chronic obstructive pulmonary disease (4.2% v 1.5% and p < 0.01), and congestive heart failure (4.4% v 1.1% and p < 0.01). After adjusting for confounders, patients pre-KT had 1.72-fold increased odds of morbidity (95% confidence interval [CI]: 1.13-2.61), 8.39-fold increased odds of MACE (95% CI: 1.13-62.18), and 2.07-fold increased odds of readmission (95% CI: 1.38-3.10). There was no difference in mortality or risk of infections.
Conclusions: Patients who underwent PTX prior to KT were at significantly increased risk for 30-day morbidity and MACE, but no different odds of mortality compared to PTX after KT. This can help inform decision-making regarding timing of PTX in patients with HPT.
期刊介绍:
World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.