Racial Disparities in Primary Hyperparathyroidism
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ORIGINAL SCIENTIFIC REPORT
Racial Disparities in Primary Hyperparathyroidism Jennifer Fieber1 • Kristin Goodsell2 • Rachel R. Kelz1,2 • Jae P. Ermer1 • Chris Wirtalla1 Douglas L. Fraker1,2 • Heather Wachtel1,2
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Accepted: 8 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT). Methods We performed a retrospective cohort study of patients undergoing parathyroidectomy for PHPT at a single center (1997–2015). Patients were classified by self-identified race, as African-American or White. The primary outcome was disease severity at referral. The secondary outcome was completeness of preoperative evaluation. Operative success and surgical cure were evaluated. Results A total of 2392 patients were included. The majority of patients (87.6%) were White. African-American patients had higher rates of comorbid disease as well as higher preoperative calcium (10.9 vs.10.8 mg/dl, p \ 0.001) and PTH levels (122 vs. 97 pg/ml, p \ 0.001). White patients were more likely to have history of bone loss documented by DXA and nephrolithiasis. African-American patients had lower rates of complete preoperative evaluation including DXA scan. Operatively, African-American patients had larger glands by size (1.7 vs. 1.5 cm, p \ 0.001) and mass (573 vs. 364 mg, p \ 0.001). We observed similar operative success (98.9 vs. 98.0%, p = 0.355) and cure rates (98.3 vs. 97.0%, p = 0.756). Conclusions At the time of surgical referral, African-American patients with PHPT have more biochemically severe disease and higher rates of incomplete evaluation. Operative success and cure rates are comparable.
Introduction Primary hyperparathyroidism (PHPT) is a common endocrine disorder. In a racially mixed population, the incidence was found to be 66 per 100,000 person-years among women, with highest prevalence among African& Heather Wachtel [email protected] 1
Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Silverstein Pavilion, Philadelphia, PA 19104, USA
2
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Americans [1]. PHPT can cause end-organ dysfunction including bone mineral density loss, nephrolithiasis, and renal insufficiency, as well as gastrointestinal and neurocognitive symptoms [2]. Parathyroidectomy is the only cure for PHPT and is indicated for symptoms and for evidence of end-organ dysfunction. Even among initially asymptomatic patients, more than a third develop symptoms over time [3, 4]. Surgery can improve patient quality of life and is the most cost-effective management strategy for primary hyperparathyroidism [5, 6]. Racial disparities in medicine are increasingly recognized, with a growing body of research investigating the relationship between race, disease severity, and outcomes. Af
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