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

BMC Surgery

Research Article

Paul J. Dluzniewski¹  Jiannong Liu²  Allan J. Collins³  Areef Ishani⁴  James B. Wetmore⁵  Geoffrey A. Block⁶ 

[1] Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA;Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, 55404, Minneapolis, MN, USA;Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, 55404, Minneapolis, MN, USA;Department of Medicine, University of Minnesota, Minneapolis, MN, USA;Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, 55404, Minneapolis, MN, USA;Department of Medicine, University of Minnesota, Minneapolis, MN, USA;Section of Renal Diseases and Hypertension, Minneapolis Veterans Administration Health Care System, Minneapolis, MN, USA;Chronic Disease Research Group, Minneapolis Medical Research Foundation, 914 South 8th Street, Suite S4.100, 55404, Minneapolis, MN, USA;Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA;Department of Medicine, University of Minnesota, Minneapolis, MN, USA;Denver Nephrology Clinical Research Division, Denver, CO, USA;

关键词: End-stage renal disease;    Dialysis;    Mineral metabolism;    Parathyroidectomy;    Secondary hyperparathyroidism;   

DOI  :  10.1186/s12893-016-0193-7

 received in 2016-06-14, accepted in 2016-11-24,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundSecondary 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.MethodsA 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.ResultsA 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.ConclusionsParathyroidectomy use varies substantially by geography in the US; the factors responsible should be further investigated.

【 授权许可】

CC BY   
© The Author(s). 2016