Aim: Primary hyperparathyroidism (PHP) is associated with many chronic conditions. Polypharmacy may, therefore, be a feature of those people with PHP considered for parathyroidectomy. This study examines the medication profile of elderly people undergoing parathyroidectomy for PHP and the association of polypharmacy with long-term survival.
Materials and methods: A publicly available Australian administrative data source describing medical services and pharmacy dispensing between 2003 and 2015 was used. Persons undergoing parathyroidectomy for PHP aged >60 years were identified from procedure codes and their dispensing profile was examined in the year prior to surgery. Polypharmacy was defined as taking more than five concomitant medications. Survival following parathyroidectomy was assessed in relation to age and polypharmacy groupings.
Results: A total of 608 persons (461:147, F:M) undergoing parathyroidectomy for PHP (mean age 72.1 years) were recruited. The prevalence of polypharmacy in parathyroidectomy-treated persons was 42%. Polypharmacy prevalence and cardiovascular treatment prevalence increased with age but were lower than control groups.
Overall, 5-year survival following parathyroidectomy for PHP was 91% (controls 88%, log-rank 0.01) and was influenced by the level of polypharmacy in all groups. The elderly aged >75 years with polypharmacy had better survival following parathyroidectomy than controls (5-year survival 0.90 vs 0.77, log-rank 0.002).
Conclusion: The prevalence of polypharmacy and cardiovascular treatments in this elderly Australian cohort undergoing parathyroidectomy for PHP is lower than controls. The long-term survival of those aged >75 with polypharmacy is better than age-matched controls. It is likely that patients undergoing parathyroidectomy for PHP are a highly selected group.
Clinical significance: Administrative data can provide a perspective of people undergoing parathyroidectomy for PHP and examine survival outcomes. Presently, Australian surgeons are rigorous in the selection of elderly patients undergoing surgery such that long-term survival outcomes appear better than those observed in control populations.
Morin L, Johnell K, Laroche ML, et al. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol 2018;10:289–298. DOI: 10.2147/CLEP.S153458
Page AT, Falster MO, Litchfield M, et al. Polypharmacy among older Australians, 2006-2017: a population-based study. Med J Aust 2019;211(2):71–75. DOI: 10.5694/mja2.50244
Laroche ML, Sirois C, Reeve E, et al. Pharmacoepidemiology in older people: purposes and future directions. Therapie 2019;74(2):325–332. DOI: 10.1016/j.therap.2018.10.006
Seib CD, Chomsky-Higgins K, Gosnell JE, et al. Patient frailty should be used to individualize treatment decisions in primary hyperparathyroidism. World J Surg 2018;42(10):3215–3222. DOI: 10.1007/s00268-018-4629-3
Vestergaard P, Mosekilde L. Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. BMJ 2003;327(7414):530–534. DOI: 10.1136/bmj.327.7414.530
Murray SE, Pathak PR, Pontes DS, et al. Timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism. Surgery 2013;154(6):1463–1469. DOI: 10.1016/j.surg.2013.09.005
Saum KU, Schöttker B, Meid AD, et al. Is polypharmacy associated with frailty in older people? Results from the ESTHER Cohort study. J Am Geriatr Soc 2017;65(2):e27–e32. DOI: 10.1111/jgs.14718
Wastesson JW, Morin L, Tan ECK, et al. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opin Drug Saf 2018;17(12):1185–1196. DOI: 10.1080/14740338.2018.1546841
Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease–a review. Eur Heart J 2004;25(20):1776–1787. DOI: 10.1016/j.ehj.2004.07.010
Khokar AM, Kuchta KM, Moo-Young TA, et al. Parathyroidectomy is safe in elderly patients: a National Surgical Quality Improvement Program study. World J Surg 2020;44(2):526–536. DOI: 10.1007/s00268-019-05280-9
Seib CD, Meng T, Suh I, et al. Undertreatment of primary hyperparathyroidism in a privately insured US population: decreasing utilization of parathyroidectomy despite expanding surgical guidelines. Surgery 2021;169(1):87–93. DOI: 10.1016/j.surg.2020.04.066
Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015;12(10):e1001885. DOI: 10.1371/journal.pmed.1001885
Collier A, Ghosh S, Nowell S, et al. Increased mortality in patients with primary hyperparathyroidism: does surgery make a difference? Endocr Pract 2019;25(4):335–339. DOI: 10.4158/EP-2018-0407
Wermers RA, Griebeler ML, Thapa P, et al. Survival in primary hyperparathyroidism over five decades (1965-2010) a population-based retrospective study. Bone 2021;152:116099. DOI: 10.1016/j.bone.2021.116099
Clifton-Bligh PB, Nery ML, Supramaniam R, et al. Mortality associated with primary hyperparathyroidism. Bone 2015;74:121–124. DOI: 10.1016/j.bone.2014.12.067
Söreide JA, van Heerden JA, Grant CS, et al. Survival after surgical treatment for primary hyperparathyroidism. Surgery 1997;122(6):1117–1123. DOI: 10.1016/s0039-6060(97)90216-6
Nilsson M, Ivarsson K, Thier M, et al. Mortality after surgery for primary hyperparathyroidism: results from a nationwide cohort. Br J Surg 2021;108(7):858–863. DOI: 10.1093/bjs/znab017
Abusahmin H, Surya A, Aldridge A, et al. Cinacalcet: a viable therapeutic option for primary hyperparathyroidism in the elderly. Indian J Endocrinol Metab 2018;22(4):485–488. DOI: 10.4103/ijem.IJEM_684_17