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Parathyroid axis monitoring may decrease the impact of bariatric hyperparathyroidism

Mon, 10/12/2020 - 11:42
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Parathyroid axis monitoring could benefit patients who at high-risk of hyperparathyroidism after bariatric surgery, according to researcher from the US, who noted that patients with renal failure, hypertension and anaemia would likely benefit from earlier follow-up with parathyroid axis monitoring (outpatient monitoring of calcium, vitamin D and PTH levels). They also reported that monitoring is likely most beneficial for patients younger than 45 years of age. The paper, 'Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review', was published in Cureus.

The authors write that enteric absorption of calcium decreases after bariatric interventions leading to the parathyroid hormone (PTH) to physiologically compensate, causing additional metabolic strain and ultimately triggering secondary hyperparathyroidism. The researchers wanted to examine the impact bariatric hyperparathyroidism has on the national healthcare system by assessing the risk of readmission and related comorbidities in this population.

Using data from the Healthcare Cost and Utilization Project Nationwide Readmission Database, the authors looked at all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), and performed a multivariate logistic regression analysis to identify factors associated with readmission for hyperparathyroidism. They also assessed non-patient variables (hospital financial model type, hospital size etc) for a socioeconomic comparison of health system utilisation.

Outcomes

From a total of 915,792 bariatric patients, 589 bariatric surgery patients were readmitted for hyperparathyroidism (0.1%). The majority were female (80.8%) and had a CCI≥2 (68.0%). After performing a multivariate regression analysis, they researchers reported that patients between the ages of 45 and 64 (OR 1.4, p=0.00) and those with Medicare (OR 3.0, p<0.001) or Medicaid (OR 2.6, p<0.001) were more likely to be readmitted after bariatric surgery for. Furthermore, patients in lower median household income quartiles were more likely to be readmitted. Smaller hospital bed size was a protective factor and patients were less likely to get readmitted along with those at investor-owned hospitals. Comorbidities associated with the highest ORs for readmission with hyperparathyroidism were renal failure (OR 17.1, p<0.001), hypertension (OR 2.9, p<0.001) and deficiency anaemias (OR 2.6, p<0.01).

They also found that between RYGB and GS patients, bypass surgery was not an independent predictor of readmission rates for hyperparathyroidism and the results suggest that at the health system level, the clinical impact of these shifting endocrine demands is similar between RYGB and SG.

“Larger public hospitals may benefit most from proactive parathyroid axis monitoring. Their large volumes and higher risk for hyperparathyroidism readmission make them ideal candidates for the implementation of these programmes,” the authors concluded. “Further quality improvement studies ought to be done to explore this benefit and its application to subclassifications of hyperparathyroidism.”

To access this paper, please click here