Effect of Delayed Parathyroidectomy on Risk of Future Cardiovascular and Nephrolithiasis Interventions in Adults With Primary Hyperparathyroidism.

Objective: To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions.

Background: Long-term, untreated primary hyperparathyroidism (pHPT) is associated with significant morbidity, including nephrolithiasis and cardiovascular disease.

Methods: We conducted a population-based cohort study of New York and California state-wide data from 2000 to 2020. Adult patients who underwent renal stone treatment and were subsequently diagnosed with pHPT and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was before the index stone procedure, they underwent second stone treatment within 6 months, with stage V chronic kidney disease, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. The rate of renal stone retreatment and cardiovascular interventions after PTX in patients with pHPT with nephrolithiasis who underwent parathyroid surgery at ≤2 years and >2 years after the index stone procedure was measured.

Results: We identified 2093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (interquartile range: 187-1477), and follow-up was 7.4 years (interquartile range: 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR=1.59; P <0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P =0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR=1.52; P <0.01).

Conclusions: In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.