Parathyroidectomy in dialysis patients: what is the risk?

e80

Scientific Poster Presentations: 2015 Clinical Congress

METHODS: We performed a retrospective cohort study of patients receiving unilateral adrenalectomy for primary hyperaldosteronism at our institution from 2001-2014. Patients were classified as “directed” (DIA) if the aldosteronoma was identified on imaging performed for hypertension or hypokalemia workup, or as “incidental” (IIA) if the aldosteronoma was identified on imaging performed for any other reason. IIA and DIA patients were compared on patient demographics, clinical history, preoperative test results, surgical pathology findings, and postoperative course. RESULTS: 210 patients were studied. 17 (8.1%) were IIA. At the time of surgical evaluation, 88% of IIA patients met criteria for primary hyperaldosteronism screening. IIA patients were younger than DIA patients, but the two groups were otherwise demographically and clinically similar. IIA patients had larger aldosteronomas than DIA patients. IIA and DIA patients had similar rates of postoperative cure and failure. CONCLUSIONS: IIA and DIA patients have comparable disease severity prior to surgical evaluation and similar rates of postoperative cure. 88% of IIA patients met criteria for evaluation of primary hyperaldosteronism, but had not received it. Increased adherence to guidelines for primary hyperaldosteronism screening will lead to more timely diagnosis and a higher potential for surgical cure. Parathyroidectomy in dialysis patients: what is the risk? Jamie Anderson, MD, Michael J Campbell, MD UC Davis Medical Center, Sacramento, CA INTRODUCTION: Patients with chronic kidney disease on dialysis commonly develop secondary and tertiary hyperparathyroidism, but are often not referred for surgical evaluation because of the belief that the risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the risks associated with parathyroidectomy in this population. METHODS: We used the American College of Surgeons National Surgical Quality Improvement Project database from 2005-2011 to evaluate risk of complications for dialysis vs non-dialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. Outcomes were also compared between dialysis patients undergoing parathyroidectomy and arteriovenous (AV) fistula creation to understand the relative risk between these procedures. RESULTS: 20,089 patients underwent parathyroidectomy. Of these, 1,330 (6.6%) were on dialysis. The unadjusted mortality rate following parathyroidectomy was higher for patients on dialysis than those not on dialysis (1.2% vs 0.1%, p<0.001). On multivariate analysis, dialysis was independently associated with increased risk of death (OR 13.12, p¼0.002). Dialysis patients had an increased incidence of complications (7.1% vs 1.4%, p<0.001), but on multivariate logistic regression, dialysis was not associated with increased morbidity (p¼0.291). When compared to patients undergoing AV fistula creation, dialysis

J Am Coll Surg

patients undergoing parathyroidectomy did not have increased odds of death (p¼0.917) or complications (p¼0.383). CONCLUSIONS: Dialysis patients who undergo parathyroidectomy have a similar risk of complications, but an increased risk of death compared to patients not on dialysis; however, the risks are similar to patients undergoing AV fistula creation. The risks of parathyroidectomy in dialysis patients are acceptable when compared to other common procedures for dialysis patients. Should 4DCT replace sestamibi as a primary localization modality in primary hyperparathyroidism? Lucia De Gregorio, MD, Carrie C Lubitz, MD, FACS, George J Hunter, MD, Richard A Hodin, MD, FACS, Randall D Gaz, MD, Sareh Parangi, MD, Antonia E Stephen, MD, FACS Massachusetts General Hospital, Boston, MA INTRODUCTION: Four-dimension computerized tomography (4DCT) is most often used when ultrasound (US) and 99mTechnetium-sestamibi (MIBI) are inconclusive in the work-up for primary hyperparathyroidism. This study analyzes the performance of these imaging modalities. METHODS: From January 2010 until December 2013, we selected 489 consecutive patients undergoing their first operation, who were normocalcemic six months following surgery. The reports of their imaging studies were compared to the surgical findings. We determined sensitivity of each test and identified factors related to false negative (FN) or false positive (FP) results. RESULTS: 489 patients underwent 481 US, 434 MIBI and 88 4DCT. 70.1% were found to have single gland disease at surgery and US, MIBI and 4DCT identified the correct gland in 64.4%, 73.2% and 73.2% of cases, respectively. 146 patients (29.9%) had multi-gland disease (MGD) and the sensitivity of US, MIBI and 4DCT was 14.6%, 3.9% and 53.1%, respectively. Older age, presence of thyroid nodules, MGD, and smaller glands were associated with FN and FP results in US and MIBI. Higher BMI and MGD were significantly associated with FP results in 4DCT. In cases with a negative US, the sensitivity of MIBI decreased from 56% to 42% (p¼0.01). The sensitivity of 4DCT was not significantly different in US-negative cases. CONCLUSIONS: Although 4DCT was performed in more challenging cases, its sensitivity was at least as good as MIBI. 4DCT’s performance in patients with negative US exams suggests that it should be considered for a first or second line study in first time parathyroid operations. Should normotensive pheochromocytoma patients be put on alpha-blockade before surgery? Navneet Tripathi, Amit AA Agarwal, MB, BS, FACS, Punit Goyal, MD, DM, Sushil Gupta, MD Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India