Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Wetmore, James; Liu, Jiannong; Dluzniewski, Paul; Ishani, Areef; Block, Geoffrey; Collins, Allan
• Is Part Of: BMC surgery. Volume 16:Issue 1(2016)
• Page Start: 1
• Page End: 6
• Publication Date: 2016-12
• Subjects: End-stage renal disease -- Dialysis -- Mineral metabolism -- Parathyroidectomy -- Secondary hyperparathyroidism; Surgery -- Periodicals; 617.005
• DOI: 10.1186/s12893-016-0193-7
• Languages: English
• ISSNs: 1471-2482

Abstract

Abstract 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.