Factors associated with complications of parathyroidectomy in the elderly: a single-center experience

Aim: With the increasing elderly population, the number of parathyroidectomy procedures is also rising among geriatric patients. Due to comorbidities and altered physiological reserves, elderly patients may face higher risks of postoperative complications. This study aims to evaluate the relationship between clinical parameters and complications related to parathyroidectomy in patients aged 65 years and older. Additionally, the study aims to identify potential risk factors for postoperative morbidity and mortality, with a focus on reducing complication rates and improving surgical safety in this population. Materials and Methods: This retrospective observational study included patients aged 65 years and older who underwent parathyroid surgery at a tertiary care center between January 2009 and February 2022. Demographic, clinical, surgical, and laboratory data were analyzed. Patients were divided into two groups based on the presence or absence of postoperative complications. A subgroup analysis was conducted for patients who developed permanent hypocalcemia. Statistical comparisons were made between groups. DEXA T scores were obtained from the lumbar spine and hip regions. Results: Elderly patients accounted for 5.9% (23/388) of all parathyroidectomy cases. The overall postoperative complication rate was 21.7%, and the rate of permanent hypocalcemia was 17.4%. Statistically significant differences were found between complication and non-complication groups in terms of free T3, preoperative ALP, PTH, and postoperative calcium levels. Histopathological findings (adenoma vs. hyperplasia) and the number of excised adenomas were significantly associated with complications and permanent hypocalcemia. Mortality was significantly higher in the complication group (p=0.017). No cases of persistent hyperparathyroidism were observed during follow-up. Additionally, a significant association was found between preoperative phosphorus levels and DEXA T-scores measured from the lumbar spine and hip. Conclusion: Parathyroidectomy in elderly patients carries a notable risk of postoperative complications. Identifying patients at higher risk based on clinical and biochemical parameters may guide preoperative planning and postoperative monitoring. Optimizing surgical techniques and perioperative care in elderly patients is essential to minimize complications and improve outcomes.