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The Impact of Treatment Choice on Long-term Outcomes in Older Adults with Primary Hyperparathyroidism

治疗选择对患有原发性甲状旁腺功能亢进症的老年人长期预后的影响

基本信息

批准号：
9751150
负责人：
Carolyn Dacey Seib
金额：
$ 11.74万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9751150
关键词：
Accounting Advocate Affect Age Aging Award Benchmarking Benefits and Risks Cardiovascular Diseases Cardiovascular system Cause of Death Characteristics Comorbidity Consensus Data Decision Making Development Diagnosis Disease Disease Progression Documentation Elderly Endocrine System Diseases Ethnic Origin Event Foundations Fracture Goals Guidelines Health Services Research Hip Fractures Hyperparathyroidism Impaired cognition Incidence Knowledge Literature Medical Medicare Medicare claim Mission Modification Morbidity - disease rate National Institute on Aging Nephrolithiasis Neurocognitive Deficit Older Population Operative Surgical Procedures Outcome Parathyroidectomy Patient Selection Patients Perioperative complication Play Population Prevalence Provider Public Health Race Renal function Research Risk Risk Factors Risk Reduction Role Rural Selection for Treatments Socioeconomic Status Surgical Management Surgical complication Symptoms Testing United States Vulnerable Populations adverse outcome beneficiary bone loss cardiovascular risk factor cohort evidence base evidence based guidelines experience fracture risk frailty functional decline improved individual patient innovation longitudinal analysis mortality older patient osteoporosis with pathological fracture patient population population based prevent skills surgical risk tool treatment choice treatment group

项目摘要

Project Summary/Abstract Primary hyperparathyroidism (PHPT) is a common endocrine disorder that predominantly affects patients older than 60 and is increasing in prevalence. Population-based data on long-term outcomes for geriatric patients who undergo parathyroidectomy or observation with medical management are lacking. Understanding which older adults will benefit from medical vs. surgical management will help reduce the burden of the late complications of PHPT, without exposing elders who will not benefit to the risks of surgery. Our long-term goal is to devise evidence-based guidelines to optimally manage older adults with PHPT with parathyroidectomy or medical therapy to reduce morbidity, functional and cognitive decline, and mortality. The overall objective of this proposed study is to quantify the impact of parathyroidectomy on the risk of subsequent fracture and major adverse cardiovascular (CV) events in older adults with PHPT, and to identify risk factors for morbidity with medical and surgical management. Our central hypothesis is that older adults with PHPT who undergo parathyroidectomy experience fewer fractures and major adverse CV events than those who do not undergo surgery, and that patient factors associated with adverse outcomes in both treatment groups can be identified and used to guide patient selection for surgery. This hypothesis will be tested using longitudinal analysis of Medicare claims data to identify a nationally representative cohort of patients with PHPT and a control cohort without PHPT to pursue two specific aims: 1) Identify factors associated with the surgical management of PHPT in older adults in the United States; and 2) Compare the 5-year incidence of and risk factors for new fractures or major adverse CV events in older adults with PHPT undergoing parathyroidectomy vs. medical management and determine the relationship between patient characteristics and adverse outcomes. This project is innovative because it will be the first study to examine the long-term outcomes of parathyroidectomy vs. medical management for PHPT in a national population older than 65 in the United States, and the first study to look at the management of PHPT in Medicare beneficiaries. The proposed research is significant because it will provide benchmark data on the long-term outcomes for geriatric patients with PHPT who undergo parathyroidectomy vs. medical management and greatly enhance our understanding of geriatric- specific predictors of adverse outcomes in the management of PHPT.

项目总结/摘要原发性甲状旁腺功能亢进（PHPT）是一种常见的内分泌疾病，主要影响老年患者 60岁以上，而且患病率在上升。老年患者长期结局的基于人群的数据缺乏接受甲状旁腺切除术或药物治疗观察的患者。了解哪些老年人将受益于医疗与手术管理将有助于减少后期的负担 PHPT的并发症，没有暴露老年人谁不会受益于手术的风险。我们的长期目标是制定循证指南，以最佳方式管理老年人PHPT与甲状旁腺切除术，降低发病率、功能和认知下降以及死亡率的药物治疗。的总体目标这项研究旨在量化甲状旁腺切除术对随后骨折风险的影响，患有PHPT的老年人发生不良心血管（CV）事件，并确定PHPT发病的风险因素内科和外科管理。我们的中心假设是，老年人与PHPT谁经历甲状旁腺切除术后发生的骨折和主要不良CV事件少于未接受手术的患者。可以确定两个治疗组中与不良结局相关的患者因素并用于指导手术患者的选择。这一假设将使用以下纵向分析进行检验：医疗保险声称数据用于确定PHPT患者的全国代表性队列和对照队列没有PHPT追求两个具体目标：1）确定与手术管理相关的因素，美国老年人PHPT的发生率; 2）比较新的PHPT的5年发病率和风险因素，接受甲状旁腺切除术与药物治疗的PHPT老年人中的骨折或重大不良CV事件管理和确定患者特征和不良结局之间的关系。这该项目是创新的，因为它将是第一个研究检查甲状旁腺切除术的长期结果 vs.在美国65岁以上的全国人口中，PHPT的医疗管理，以及第一个该研究旨在研究医疗保险受益人中PHPT的管理。所提出的研究是有意义的因为它将为老年PHPT患者的长期结局提供基准数据，接受甲状旁腺切除术与医疗管理，并大大提高我们对老年人的理解- PHPT治疗中不良结局的特定预测因素。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Racial disparities in the utilization of parathyroidectomy among patients with primary hyperparathyroidism: Evidence from a nationwide analysis of Medicare claims.

DOI：
10.1016/j.surg.2021.05.037
发表时间：
2022-01
期刊：
Surgery
影响因子：
3.8
作者：
Alobuia WM;Meng T;Cisco RM;Lin DT;Suh I;Tamura MK;Trickey AW;Kebebew E;Seib CD
通讯作者：
Seib CD

Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns.

通过患者教育和提供者处方模式减少内分泌手术中阿片类药物的使用。