Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis

作者：Wetmore James B^*; Liu Jiannong; Dluzniewski Paul J; Ishani Areef; Block Geoffrey A; Collins Allan J

来源：BMC Surgery, 2016, 16(1): 77.

DOI：10.1186/s12893-016-0193-7

• End-stage renal disease
• Dialysis
• Mineral metabolism
• Parathyroidectomy
• Secondary hyperparathyroidism

Background: Secondary hyperparathyroidism (SHPT) is associated with adverse outcomes in patients receiving maintenance dialysis. Parathyroidectomy is a treatment for SHPT; whether parathyroidectomy utilization varies geographically in the US is unknown.
Methods: A retrospective cohort analysis was undertaken to identify all patients aged 18 years or older who were receiving in-center hemodialysis between 2007 and 2009, were covered by Medicare Parts A and B, and had been receiving hemodialysis for at least 1 year. Parathyroidectomy was identified from inpatient claims using relevant International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Patient characteristics and End-Stage Renal Disease Network (a proxy for geography) were ascertained. Adjusted odds ratios for parathyroidectomy were estimated from a logistic model.
Results: A total of 286,569 patients satisfied inclusion criteria, of whom 4435 (1.5%) underwent PTX. After adjustment for a variety of patient characteristics, there was a 2-fold difference in adjusted odds of parathyroidectomy between the most-and least-frequently performing regions. Adjusted odds ratios were more than 20% higher than average in four networks, and more than 20% lower in four networks.
Conclusions: Parathyroidectomy use varies substantially by geography in the US; the factors responsible should be further investigated.

• 出版日期2016-11-29