PARATHYROIDECTOMY IN THE ELDERLY - DO THE BENEFITS OUTWEIGH THE RISKS

Although the incidence of hyperparathyroidism (HPT) in the elderly exc eeds 1.5%, limited resources and co-morbidity inhibit referral for par athyroidectomy. To determine the risks and benefits of surgery, we exa mined the outcomes of elderly patients who underwent exploration for p rimary HPT, Data from 211 consecutive patients who underwent parathyro idectomy by one surgeon at the Johns Hopkins Hospital between August 1 990 and May 1996 were recorded prospectively. Of these patients, 184 h ad primary HPT, Demographic and outcome data of elderly patients (> 70 years of age) (n = 36) were compared to those from younger patients ( < 70 years of age) (n = 148). Preoperative symptoms of mental impairme nt, bone disease, and fatigue were more common in elderly patients (p < 0.05), and nephrolithiasis was more frequent in younger patients (p < 0.025). Elderly patients presented with more advanced disease, manif ested by higher preoperative parathyroid hormone Levels (301.9 +/- 63. 3 vs. 169.2 +/- 14.3 pg/ml, p < 0.05). The cure rate (94.4%), morbidit y (5.5%), and mortality (0%) in the elderly mere indistinguishable fro m those of their younger cohorts (98%, 1.4%, and 0%, respectively). In conclusion, the more advanced disease seen in the elderly suggests th at they are referred for surgery with a higher threshold than younger patients, Although several series of parathyroidectomy in elderly pati ents have reported high morbidity rates, significant mortality, and lo ng length of stay (LOS), we found that parathyroidectomy in these pati ents can be performed with high cures, low morbidity, no mortality, sh ort LOS, and high patient satisfaction, These data suggest that the be nefits of surgery outweigh its risks and argue for a lower threshold f or referral of elderly patients with primary HPT for surgical treatmen t.