Evaluation of postoperative morbidity and age relationship in patients undergoing parathyroid surgery

Primary hyperparathyroidism is an endocrine disease that predominantly affects the elderly and is increasingly common. It is seen 2-3 times more frequently in women than in men. Incidence rates increase with age and peak in age groups over 60. Parathyroidectomy is the primary treatment option for primary hyperparathyroidism. Surgical treatment is also an appropriate alternative for patients with secondary primary hyperparathyroidism and tertiary hyperparathyroidism who are unresponsive to medical treatment. Parathyroidectomy is generally a straightforward and simple procedure, such that many advocates for parathyroidectomy to be performed in an outpatient setting due to its low morbidity and mortality risk. According to data from the World Health Organization, the number and proportion of people aged 60 and over in the population is increasing. In 2019, the number of people aged 60 and over was 1 billion, and this number is expected to rise to 1.4 billion by 2030 and 2.1 billion by 2050. This increase will accelerate especially in developing countries in the coming years. In this study, by comparing parathyroidectomy patients according to age, demographic and procedure-related variables, outcomes, morbidity rate, and type will be evaluated. It will be investigated whether parathyroidectomy is a safe treatment option in elderly patients. Patients who underwent parathyroidectomy at Akdeniz University Faculty of Medicine Hospital, Department of General Surgery, between 2018 and 2023, after a decision for surgery was made by a multidisciplinary endocrine surgery council, were included in the study. The patients were evaluated for demographic characteristics, American Society of Anesthesiologists (ASA) scores, and comorbidities; and were divided into three groups: 44 years and under, between 45-59 years, and 60 years and over. Preoperative calcium and parathyroid hormone values, postoperative calcium and parathyroid hormone values, lesion locations, postoperative histopathological results, preoperative symptomatology, and postoperative complication (hypocalcemia, bleeding, hoarseness) rates were examined. Of the 303 patients included in the study, 236 were female (77.9%) and 67 were male (22.1%). The age group distribution was 76 patients (25.1%) aged 44 and under, 137 patients (45.2%) aged 45-59, and 90 patients (29.7%) aged over 60. 274 patients (90.4%) were operated for primary hyperparathyroidism, 10 (3.3%) for secondary hyperparathyroidism, and 19 (6.3%) for tertiary hyperparathyroidism. Statistical analysis showed that primary hyperparathyroidism was significantly more common in the 45-59 and 60 and over age groups compared to the 44 and under age group (p<0.001). Secondary and tertiary hyperparathyroidism diagnoses were significantly more frequent in the under-44 age group compared to other age groups (p<0.001). The number of hospitalization days was significantly higher in patients aged 44 and under compared to those aged 45-59 (p=0.022). The most common postoperative morbidity was hematoma (5.6%). Hematoma was followed by hungry bone syndrome (4.3%), transient hypocalcemia (3.3%), surgical site infection (3%), and persistent hyperparathyroidism (3%). Among postoperative morbidities, only hungry bone syndrome showed a statistically significant difference between age groups (p=0.001). The incidence of hungry bone syndrome in patients aged 44 and under (11.8%) was significantly higher than in those aged 45-59 (2.9%). In patients with hungry bone syndrome, bilateral exploration, multiple gland excision, and a diagnosis of secondary hyperparathyroidism were significantly more frequent (p<0.001). Parathyroidectomy is a surgical method that can be safely performed regardless of age. However, the findings of our study show that factors determining postoperative morbidity are not limited to age alone, but are also associated with many variables such as preoperative diagnosis, accompanying systemic diseases, surgical approach, and intraoperative management strategies. Especially in the younger age group, the higher rates of secondary and tertiary hyperparathyroidism increase the risk of complications, while in the elderly group, careful follow-up is required due to systemic comorbidities. Therefore, when conducting risk assessments prior to parathyroid surgery, not only chronological age but also clinical and biochemical features should be considered, and a multidisciplinary and individualized approach should be adopted. Key Words: Primary Hyperparathyroidism, Secondary Hyperparathyroidism, Tertiary Hyperparathyroidism, Parathyroidectomy, Geriatric Population, Postoperative Morbidit