Abstract
BACKGROUND: Parathyroid surgery is an appropriate alternative for renal hyperparathyroidism (rHPT) in patients in whom medical therapy fails. European morbidity and outcome data for clearly defined cohorts, potentially reflecting contemporary clinical practice, remain scarce. METHOD: Data were extracted from the EUROCRINE® database on all operations for secondary rHPT between 1 January 2015 and 31 December 2021. Multivariable logistic regression analysis was used to identify risk factors for complications. Subgroup analyses were conducted for the two major surgical approaches (subtotal parathyroidectomy or total thyroidectomy with parathyroid transplantation), as well as for redo and concomitant thyroid surgery. The primary outcome was 30-day morbidity. RESULTS: After excluding 324 patients, data were analysed for 1165 patients, who underwent primary surgery (859), redo surgery (135), or parathyroid surgery with concomitant (planned or unplanned) thyroid surgery (171). The postoperative complication rate was 13.8% (161 patients). Reintervention for bleeding was necessary in 22 patients (1.9%). The length of hospital stay was >1 week in 108 patients (9.8%), and was shorter in the redo parathyroidectomy than first-time parathyroidectomy group (52.0% (66) versus 36.6% (299) discharged within 2 days, respectively). No risk factors for complications could be identified in either the overall or subgroup analyses. In the case of redo surgery or primary surgery with concomitant thyroid surgery, recurrent laryngeal nerve palsy (6.7 versus 3.5%, respectively), revision surgery for bleeding (2.2 versus 1.2%, respectively), and wound infection rates (0.7 versus 0.0%, respectively) remained low. CONCLUSION: This large European multicentre cohort study demonstrates the safety and low morbidity of parathyroid surgery for rHPT.