Image-directed parathyroidectomy under local anaesthesia in the elderly

BACKGROUND: Surgical morbidity and mortality rates are increased in elderly patients. The aim of this study was to evaluate the outcome of targeted parathyroid operations in patients over the age of 70 years. METHODS: Forty patients aged over 70 years underwent targeted parathyroidectomy for primary hyperparathyroidism (HPT). Data were collected prospectively and reviewed retrospectively. RESULTS:: There were 33 women and seven men with a mean age of 78 (range 70-92) years, all of whom had symptoms attributable to HPT. A solitary parathyroid adenoma was detected by ultrasonography and/or sestamibi scintigraphy before operation in all patients. Six patients had a history of neck surgery, including two with persistent or recurrent HPT. Thirty-three patients underwent neck exploration under local anaesthesia with intravenous sedation. Following parathyroidectomy, intraoperative parathyroid hormone levels normalized in 39 of 40 patients and accurately predicted postoperative eucalcaemia. Intraoperative findings included 37 solitary adenomas, one double adenoma and two carcinomas. One patient with persistent HPT developed severe hypoparathyroidism following targeted parathyroid exploration with autotransplantation. Twenty-nine patients were discharged from hospital on the day of surgery. Nineteen of 21 patients for whom data were available reported an improvement in symptoms. CONCLUSION: A focused neck exploration provides a safe and effective alternative to bilateral neck exploration in elderly patients in whom a solitary parathyroid adenoma has been localized before operation. Targeted parathyroidectomy under local anaesthesia is recommended in most elderly patients with HPT.