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.

项目摘要/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，主要影响年龄较大的患者大于60，并且患病率正在增加。基于人群的老年患者长期结局的数据缺乏进行甲状旁腺切除术或对医疗管理进行观察的人。了解哪个老年人将从医疗与手术管理中受益，将有助于减轻晚期的负担 PHPT的并发症，而不会暴露不利于手术风险的长辈。我们的长期目标是制定基于证据的指南，以最佳地管理具有甲状旁腺切除术或降低发病率，功能和认知能力下降以及死亡率的药物疗法。总体目标这项拟议的研究是量化甲状旁腺切除术对随后骨折和主要裂缝风险的影响患有PHPT的老年人的不良心血管（CV）事件，并确定发病率的危险因素医学和外科管理。我们的中心假设是患有PHPT的老年人甲状旁腺切除术经历的骨折和重大不良简历事件的经历少于那些不经历的事件手术，以及两个治疗组中与不良结果相关的患者因素并用于指导患者选择手术。该假设将通过纵向分析对 Medicare声称数据以识别具有PHPT和对照组的患者的全国代表性队列没有PHPT来追求两个具体目标：1）确定与手术管理相关的因素美国老年人的PHPT； 2）比较新的5年发病率和风险因素 pHPT的老年人进行甲状旁腺切除术与医学管理并确定患者特征和不良结果之间的关系。这项目具有创新性，因为它将是第一个研究甲状旁腺切除术的长期结局的研究在美国65岁以上的全国人口中，PHPT的医疗管理和医疗管理，第一个研究Medicare受益人中PHPT的管理。拟议的研究很重要因为它将为老年pHPT的老年患者提供基准数据接受甲状旁腺切除术与医疗管理，并大大增强我们对老年病的理解 PHPT管理中不良结果的特定预测指标。

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。