# Age-Related Differences in Surgical and Biochemical Outcomes Following Parathyroidectomy for Primary Hyperparathyroidism

## TL;DR

This study shows that parathyroidectomy is safe and effective for treating primary hyperparathyroidism in all age groups, including older patients with health issues.

## Contribution

The study provides evidence that parathyroidectomy is safe and beneficial for older patients with primary hyperparathyroidism.

## Key findings

- Older patients had more comorbidities like hypertension and diabetes, but complication rates after surgery were similar across age groups.
- All age groups showed normalization of calcium and parathyroid hormone levels post-surgery.
- Younger patients had greater reductions in bone turnover markers after surgery, but all groups showed improvement.

## Abstract

Background/Objectives: Despite its increasing incidence in older patients, parathyroidectomy for primary hyperparathyroidism (PHPT) is frequently deferred owing to risks and age-related comorbidities and the limited evidence of age-specific surgical safety and biochemical outcomes. We evaluate age-related differences in clinical characteristics, perioperative outcomes, postoperative complications, and biochemical responses, including bone turnover markers, after parathyroidectomy for PHPT. Methods: We retrospectively enrolled 596 patients who underwent parathyroidectomy between 2009 and 2022, stratified into three age groups: <65, 65–74, and ≥75 years (Group A, n = 401; Group B, n = 141; and Group C, n = 54, respectively). Demographics, comorbidities, operative details, complications, pathology, and biochemical parameters were compared between the groups. Results: Older patients exhibited a higher prevalence of hypertension, cardiovascular disease, diabetes, osteoporosis, and chronic kidney disease (all p < 0.01), whereas multiple endocrine neoplasias were more frequent in younger patients (p = 0.002). Younger patients had a longer operation time (p = 0.006). There were no significant intergroup differences in postoperative hospital stay and complication rates, including transient hypoparathyroidism, hungry bone syndrome, and recurrent laryngeal nerve injury. Pathologic diagnoses were comparable, with single adenoma being most common (81.0–86.2%). The postoperative calcium and parathyroid hormone levels normalized in all groups. Younger patients had higher baseline bone turnover markers and demonstrated greater absolute reductions postoperatively (p = 0.030 and p = 0.042, respectively); however, improvements were observed in all age groups. Conclusions: When appropriately selected, parathyroidectomy is safe and effective in all age groups, including older patients with comorbidities. Considering its evident biochemical and skeletal benefits, age should not preclude surgical intervention for PHPT.