K. Zanocco1,2, Z. Butt1,2,3, D. Kaltman1, D. Elaraj1, D. Cella2,3, J. L. Holl2, C. Sturgeon1 1Northwestern University,Department Of Surgery,Chicago, IL, USA 2Northwestern University,Center For Healthcare Studies,Chicago, IL, USA 3Northwestern University,Department Of Medical Social Sciences,Chicago, IL, USA
Introduction:
The majority of patients with primary hyperparathyroidism (PHPT) are diagnosed incidentally and many are without the classic signs of renal or osseous complications. The NIH Patient Reported Outcomes Measurement Information System (PROMIS®) contains validated measures of physical and mental health that can be efficiently administered to patients using computer-adapted testing. The objective of this study was to describe changes in PHPT patient-reported health before and after curative parathyroidectomy and assess the feasibility of PROMIS use in the outpatient clinical setting. We hypothesized that patients with PHPT would report greater improvement in mental and physical health compared to controls.
Methods:
Adult PHPT patients scheduled for parathyroidectomy and control patients requiring diagnostic thyroid surgery at an academic medical center were prospectively enrolled during a 6-month period. Stakeholders identified 12 of the most relevant PROMIS health domains to assess PHPT symptoms. Patients were administered computer-delivered measures of these domains at a preoperative visit and 3 weeks after surgery. A change in score of 5 or greater for each PROMIS instrument was defined as clinically significant. Statistical significance of pre/post-surgery changes in scores was determined using paired t-tests. Simple linear regression modeling was performed to examine the relationship between preoperative serum calcium levels and physical health scores.
Results:
35 PHPT patients and 9 control patients completed the study. The mean number of items answered during an assessment was 67 (range 51 to 121, SD 15.4). Median completion time was 8.2 minutes (range 3.4 to 38.4, SD 4.7). When compared to the control group, PHPT patients who underwent curative parathyroidectomy had statistically and clinically-significant improvement in the PROMIS domains of Fatigue, Pain Intensity, Physical Function, Sleep-Related Impairment, Anxiety, Applied Cognition, and Depression. (Table 1) A linear relationship in PHPT patients between serum calcium concentration and PROMIS Fatigue score was observed (p=0.02, adjusted R-squared=0.10, correlation=0.35).
Conclusion:
PROMIS is an efficient clinical assessment platform for patient-reported outcomes in PHPT. Several domains of physical and mental health in patients with PHPT exhibit clinically and statistically significant improvement after parathyroidectomy.
