Abstract
The previous finding of an increased risk of premature death in a consecutive series of 896 patients operated on for primary hyperparathyroidism between 1953 and 1982 [1] raised the question of the role that surgery plays in relation to the risk of death. In the present study, undertaken to examine that issue, 3 factors—age, calendar year of surgery, and time passed after surgery—have been found to be significantly related to the risk of death (p<0.001), each factor contributing independently. A correlation was found between a late calendar year of surgery and a low degree of hyperparathyroidism as evaluated by serum calcium and creatinine levels. There was an increased risk of premature death in all age groups. The risk was less among patients operated on in later years. The observed normalization of the increased risk of death with time after surgery also took place sooner in patients operated on in later years. Our finding of improved survival following surgical intervention contrasts favorably with the findings of others in studies of subjects with untreated mild hyperparathyroidism. We have also found that preoperative serum calcium levels affect the risk of death, and that there is an additional factor related to the calendar year of surgery affecting the risk of death. Circumstantial evidence indicates that the duration of hyperparathyroidism contributes to this factor. Our results also show that early surgery decreases the risk of premature death in mild cases of the disease.
Résumé
Il a été démontré dans une étude antérieure portant sur 896 patients vus de façon consécutive et opérés pour hyperparathyroïdie primitive entre 1953 et 1982 [1] que le risque postopératoire de mort précoce était augmenté. Ceci pose la question de savoir quel rôle joue la chirurgie dans ce risque. Le but de cette étude a été d'examiner ce rôle. On a mis en évidence 3 facteurs indépendants, correlés de façon significative avec le risque de mort (p<0.001): âge, année de l'acte chirurgical, et intervalle écoulé depuis l'acte chirurgical. L'année tardive de l'acte chirurgical et le degré d'hyperparathyroïdie, évalué par la calcémie et la créatininémie, étaient correlés entre eux. Le risque de mort précoce était augmenté chez tous les patients, quel que soit leur âge. Ce risque était toutefois moindre chez les patients opérés pendant ces dernières années. Le risque de mort en rapport avec la durée de l'intervalle écoulé depuis l'acte chirurgical s'est normalisé d'autant plus vite que le malade a été opéré plus tard dans la période d'étude. La survie postchirurgicale dans cette étude, contraste avec les résultats des sujets ayant une hyperpathyroïdie modérée non traitée. Nous avons trouvé également que la calcémie préopératoire était correlée avec le risque de mort et que l'année de l'acte chirurgical était sans doute en rapport avec la durée même de l'hyperparathyroïdie. Nos résultats démontrent que la chirurgie pratiquée au début dans l'hyperparathyroïdie modérée diminue le risque de mort précoce.
Resumen
El hallazgo, previamente informado, de muerte precoz en una serie consecutiva de 896 pacientes operados por hiperparatiroidismo primario entre 1953 y 1982 [1], planteó el interrogante sobre el papael de la cirugía en relación con el riesgo de muerte. En el presente estudio, emprendido con el propósito de examinar este fenómeno, se encontraron 3 factores significativamente relacionados con el riesgo de muerte (p<0.001) cada uno con una contribución independiente: edad, año calendario de la cirugía, y tiempo transcurrido después de la cirugía. Se encontró correlación entre un ano calendario tardio de la cirugía y un bajo grado de hiperparatiroidismo, según evaluación por los niveles séricos de calcio de creatinina. Se presentó un riesgo aumentado de muerte precoz en todos los grupos de edad. El riesgo fue menor en los pacientes operados en los últimos años. La normalización del riesgo aumontado de muerte con el lapso postoperatorio también se observó en los pacientes operados en los últimos años. Nuestros hallazgos de mejor supervivencia después de la intervención quirúrgica contrastan favorablemente con los hallazgos en otros estudios sobre pacientes con hiperparatiroidismo leve no tratado. También encontramos que los niveles preoperatorios de calcio sérico afectan el riesgo de enfermedad, y que existe un factor adicional relacionado con el año calendario de la cirugía; evidencia circunstancial indica que la duración del hiperparatiroidismo contribuye a este factor. Nuestros resultados muestran que la cirugía temprana disminuye el riesgo de muerte precoz también en los casos de hiperparatiroidismo leve.
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Supported by grants from the Göteborg Medical Society, the Faculty of Medicine, University of Göteborg, the King Gustav V Jubilee Clinic Research Foundation, Sahlgrenska sjukhuset's Foundation (Gunhild Karlsson's donation), and the Swedish Medical Research Council (6534).
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Hedbäck, G., Odén, A. & Tisell, LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J. Surg. 15, 399–405 (1991). https://doi.org/10.1007/BF01658740
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DOI: https://doi.org/10.1007/BF01658740