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

项目摘要/摘要 原发性甲状旁腺功能亢进症(PHPT)是一种常见的内分泌疾病，主要影响老年患者 超过60岁，而且患病率正在上升。老年患者长期预后的基于人群的数据 缺乏接受甲状旁腺切除术或接受内科治疗的观察者。了解哪些内容 老年人将受益于内科和外科治疗，这将有助于减轻老年人的负担 PHPT的并发症，而不会暴露老年人谁不会受益于手术的风险。我们的长期目标 是设计基于证据的指南，以最佳方式处理老年甲状旁腺切除术或甲状旁腺切除术的老年人 减少发病率、功能和认知能力下降以及死亡率的药物治疗。总的目标是 这项拟议的研究旨在量化甲状旁腺切除术对继发骨折和主要 老年PHPT患者的心血管不良事件，并确定发病率的危险因素 内科和外科管理。我们的中心假设是患有PHPT的老年人 与未行甲状旁腺切除术的患者相比，行甲状旁腺切除术的患者骨折和主要不良心血管事件较少。 手术，并且两个治疗组中与不良结果相关的患者因素都可以确定 并用于指导手术患者的选择。这一假设将通过以下纵向分析进行检验 联邦医疗保险声称有数据来确定具有全国代表性的PHPT患者队列和对照队列 在没有PHPT的情况下实现两个具体目标：1)确定与手术治疗相关的因素 美国老年人中的PHPT；以及2)比较新发病的5年发病率和危险因素 接受甲状旁腺切除术的老年PHPT患者的骨折或主要不良心血管事件与内科治疗相比 管理，并确定患者特征和不良后果之间的关系。这 该项目具有创新性，因为它将是第一个研究甲状旁腺切除术的长期结果的研究 美国65岁以上人口对PHPT的医疗管理，也是第一个 研究如何在医疗保险受益人中管理PHPT。这项拟议的研究具有重要意义 因为它将为患有PHPT的老年患者提供长期预后的基准数据 接受甲状旁腺切除术与内科治疗相比，大大提高了我们对老年人的认识- PHPT管理中不良后果的特定预测因素。

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.