Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study
Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study
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DOI：
10.1007/s12020-022-03153-1
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发表时间：
2022-08-01
期刊：
影响因子：
3.7
通讯作者：
Horii, Arata
中科院分区：
文献类型：
--
作者：
Takahashi, Takeshi;Yamazaki, Keisuke;Horii, Arata
目的：持续性甲状旁腺功能减退症（hypoPT）是甲状腺全切除术的主要并发症。尽管如此，由于患者选择偏差，先前的报道可能低估了hypoPT的患病率。我们的目的是估计甲状腺全切除术后持续性甲状腺功能减退的实际患病率，并寻找术后甲状腺功能减退的预测因素。方法本研究回顾性分析了日本医疗数据中心有限公司提供的健康保险索赔数据库中的数据。从2009年到2019年，使用医疗程序代码确定了2388名接受甲状腺全切除术的患者。持续的hypoopt被定义为术后50 - 10年的活性维生素D补充剂处方和hypoopt代码的分配。在两个不同的水平上估计持续性hypoPT的患病率：有或没有术后骨质疏松症和/或肾功能衰竭代码的最小值和最大值。在几个人口学和临床变量中调查了持续性假说的相关因素。结果2388例患者中，女性1752例（73.4%），平均年龄45岁。疾病类型：良性甲状腺疾病（235例）、恶性甲状腺肿瘤（1570例）、Graves病（558例）、恶性甲状腺合并Graves病（25例）。持续性假说患病率的最小值和最大值分别为15.0%和20.3%。多因素logistic回归分析显示，恶性肿瘤（比值比为1.8）与持续性hypoopt独立相关。结论基于索赔的数据库估计的甲状腺全切除术后持续hypoopt的患病率高于先前的认识。全面尝试保持甲状旁腺功能，特别是在恶性疾病，是必不可少的。
Purpose Persistent hypoparathyroidism (hypoPT) is a major complication of total thyroidectomy. Nonetheless, previous reports may have underestimated the prevalence of hypoPT due to patient selection bias. We aimed to estimate the actual prevalence of persistent hypoPT after total thyroidectomy and to find predictive factors for postoperative hypoPT. Methods This study retrospectively reviewed data from a health insurance claims-based database provided by the Japan Medical Data Center Co., Ltd. From 2009 to 2019, 2388 patients who underwent total thyroidectomy were identified using the medical procedure codes. Persistent hypoPT was defined as the prescription of active vitamin D supplements for >1 year postoperatively and the assignment of hypoPT codes. The prevalence of persistent hypoPT was estimated at two different levels: minimum and maximum estimations with or without postoperative osteoporosis and/or renal failure codes. Correlates for persistent hypoPT were investigated among several demographic and clinical variables. Results Of the 2388 patients, 1752 (73.4%) were women with a mean age of 45 years. The types of diseases were: benign thyroid disease (n = 235), malignant thyroid tumors (n = 1570), Graves ' disease (n = 558), and malignancy combined with Graves' disease (n = 25). The minimum and the maximum estimation of the prevalence of persistent hypoPT were 15.0 and 20.3%, respectively. Multivariate logistic regression analysis showed that the malignant tumor (odds ratio, 1.8) independently correlated with persistent hypoPT. Conclusions The prevalence of persistent hypoPT after total thyroidectomy estimated by the claims-based database was higher than previously recognized. Comprehensive attempts to preserve parathyroid function, especially in malignant diseases, are essential.