Changes In Frailty Following Parathyroid And Thyroid Surgery
Linwah Yip, *Daniel E Hall, *Arydann Recker, Kelly L McCoy, Sally E Carty
University of Pittsburgh, Pittsburgh, PA
OBJECTIVE(S): Frailty is a progressive syndrome of diminishing reserve. Tools that measure frailty assess symptoms and comorbidities which may be impacted by parathyroid disease in particular. To test the hypothesis that surgical treatment of hyperparathyroidism improves frailty, we conducted a prospective cohort comparison of frailty outcomes following either parathyroid exploration or thyroidectomy.
METHODS: A 14-item instrument assessing 11 variables (Risk Analysis Index for Frailty, RAI-F) was prospectively and routinely assessed in all patients undergoing parathyroid exploration (Para) or total thyroidectomy (TT) for standard indications. RAI-F was prospectively and routinely assessed longitudinally at the pre-, post-operative, and last surgical follow-up visits. In validation studies specifically in surgical patients, RAI-F scores ranged from 0-81 with higher scores correlating to 30- and 365-day mortality.
RESULTS: Compared to patients who had TT (n=141), Para patients (n=184) were older (mean age 63±13 years v. 51±14, p=0.001), more likely to be male (28% v. 18%, p=0.05), and had marginally longer surgical follow-up (mean 6.6 months v. 4.8, p<0.001). Postoperative complications were equivalently observed (Para 4% v. TT 6%, p=0.5). Mean preoperative RAI-F scores were higher in Para patients (24±9 v. TT 17±8, p<0.001), and mean postoperative and last follow-up scores did not change from preoperative scores following either Para (p=0.09 and 0.09) or TT (p=0.61 and 0.54). When longitudinal changes were assessed by patient, a 20% decrease in RAI-F corresponding to frailty improvement was observed at equal proportions following Para and TT at early (18% v. 17%, p=1) and last follow-up (13% v. 13%, p=1). However, although not observed at the early postoperative visit (9% vs 10%, p=0.14), Para patients were less likely than TT patients to exhibit a 20% increase in RAI-F at last follow-up, suggesting that Para slowed frailty progression (1% vs 19%, p=0.01).
CONCLUSIONS: In this prospective pilot study of frailty response utilizing a validated assessment tool, Para patients were older and more frail at baseline than those who received TT. Despite increased fragility, the surgical correction of hyperparathyroidism was not associated with longitudinal worsening of preoperative frailty, as it surprisingly was for TT, but instead appeared to maintain baseline health.
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