M. Phillips1, R. Akhund1, C.M. McLeod1, Z. Song1, J. Fazendin1, B. Lindeman1, A. Gillis1, H. Chen1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: The effect of obesity on various surgical outcomes, such as prolonged duration of surgery, increased wound infections, and longer postoperative hospital stays, has been widely studied. This is particularly relevant for procedures addressing endocrine disorders, where Body Mass Index (BMI) may impact the disease process. Super obesity, known as a BMI ≥ 50, presents unique challenges in the context of surgery, including increased rates of critical care interventions and infectious complications. Despite the rising prevalence of super obesity, its specific effects on parathyroidectomy complications and outcomes remain underexplored. This study aims to answer the question of whether the surgical risks, recovery, and success/failure rates call for a closer look at the benefits vs. risk profile of parathyroidectomy in the super obese population.
Methods: This retrospective cohort study analyzed 3206 patients who underwent parathyroidectomy (PTX) at a tertiary care center from 2000 to 2024. We examined patient demographics, pre- and post-operative calcium, parathyroid hormone (PTH), vitamin D levels, post-op complications, and cure rates as defined by an appropriate intraoperative PTH drop. Patients were categorized by BMI into two groups; non-super-obese (BMI <50) and super obese (BMI ≥ 50). Statistical analyses, including chi-square tests and independent samples t-tests, were used to compare complications and cure rates between the groups.
Results: There were 84 patients in the super-obese group and 3076 in the non-super-obese group. Significant differences in baseline characteristics between super-obese and non-super-obese groups included age (mean ± SEM) (54.7 ± 1.4 vs. 58.8 ± 0.3 years respectively, p = 0.01) and preoperative Vitamin D levels (mean ± SEM) (26.7 ± 2.0 ng/mL vs. 32.7 ± 0.3 ng/mL respectively, p < 0.001). The super-obese group had a higher rate of double adenomas (18.1% vs. 10.5%, p = 0.03) and malignancies (3.6% vs. 0.1%, p < 0.001). In addition, the super-obese group had a higher incidence of inpatient hospitalization (32.5% vs. 15.3%, p < 0.001) and lower cure rates based on intraoperative PTH drop (92.8% vs. 98.1%, p < 0.001). There were no significant differences between the groups in complications including transient hypocalcemia, transient hoarseness, permanent hypocalcemia, permanent hoarseness, or recurrence rate.
Conclusion: This study highlights unique challenges super-obese patients face when undergoing parathyroidectomy, including higher rates of double adenomas and malignancies and lower rates of achieving a cure for their hyperparathyroidism. Patients with super-obesity have an overall comparable complication rate compared to their non-super-obese counterparts. Parathyroidectomy in the super obese can be performed safely at high volume centers.