Race Impacts Operative Outcomes after Parathyroidectomy for Secondary and Tertiary Hyperparathyroidism

INTRODUCTION: Racial disparity exists in the care of patients with end-stage renal disease. It may be more pronounced for patients with secondary hyperparathyroidism (2HPT) and tertiary hyperparathyroidism (3HPT), because limited evidence-based guidelines for operative referral exist, despite the known long-term morbidity and mortality benefits of parathyroidectomy. We examined the association between race and adverse operative outcomes after parathyroidectomy for patients with 2HPT and 3HPT. METHODS: The American College of Surgeons NSQIP database was queried to identify patients with 2HPT and 3HPT who underwent parathyroidectomy between 2015 and 2019. Patients with 2HPT and 3HPT were analyzed separately. Patients were stratified by race (White vs non-White). Descriptive statistics were calculated and outcomes compared between each race. The primary outcome measures were 30-day morbidity and mortality. Secondary outcome measures included unplanned reoperation, readmission, and increased hospital length of stay (LOS). RESULTS: A total of 1,412 parathyroidectomies were included: 1,150 for 2HPT and 262 for 3HPT. Of these, 753 (65.5%) patients with 2HPT and 139 (53.1%) with 3HPT were non-White. Overall mortality was less than 1% in both cohorts and did not differ based on race. Overall morbidity was 6.9% for 2HPT and 2.3% for 3HPT, with a 1.7-fold increased risk seen in non-White patients with 2HPT. Non-White patients with 2HPT were 2 times more likely to require reoperation, and more frequently required reoperation for bleeding (2.0% vs 0.3%, p = 0.017). Race was associated with increased LOS in both cohorts (Table 1). Table 1. - Impact of Race on the Risk of Adverse Outcomes After Parathyroidectomy for 2HPT and 3HPT Characteristic OR * 95% CI p Value Non-White patients with secondary hyperparathyroidism Morbidity 1.722 1.013–2.929 0.043 Unplanned reoperation 2.073 1.055–4.072 0.031 LOS >3 days 1.366 1.068–1.745 0.013 Non-White patients with tertiary hyperparathyroidism Morbidity 0.323–9.961 0.687 Unplanned reoperation 2.257 0.430–11.851 0.453 LOS >2 days 1.819 1.017–3.254 0.042 *The odds ratio (OR) is for non-White patients in relation to White patients. CONCLUSION: Race impacts overall morbidity and the occurrence of adverse operative outcomes after parathyroidectomy for advanced secondary and tertiary hyperparathyroidism.