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Surgery. 2012 Mar;151(3):471-6. doi: 10.1016/j.surg.2011.07.043. Epub 2011 Oct 13.

Primary hyperparathyroidism in the underinsured: a study of 493 patients.

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  • 1Division of Endocrine Surgery, University of Miami, Miami, FL, USA.

Abstract

BACKGROUND:

Disparities may exist in the care of patients with primary hyperparathyroidism (HPT). This study examines the presentation and outcomes of underinsured patients undergoing parathyroidectomy.

METHODS:

We divided 493 HPT patients who underwent initial parathyroidectomy from 2000 to 2008 at a single institution into 2 groups: underinsured patients (group 1; n = 94) evaluated and treated at a county hospital, and patients with insurance (group 2; n = 399). Univariate and multivariate analysis adjusting for race and ethnicity were conducted to determine the association of being underinsured with several clinical variables.

RESULTS:

More patients in group 1 compared with group 2 were of black or Hispanic background (92% vs. 44%; P < .0001). Group 1 patients had higher mean preoperative serum calcium and PTH levels: 12.1 vs. 11.8 mg/dL (P = .009) and 263 vs. 198 pg/mL (P = .03), respectively. Seven group 1 (7.4%) and 7 group 2 (1.8%) patients presented with hypercalcemic crisis (P = .003). On multivariate analysis, underinsurance was associated with higher serum calcium levels (P = .011) and hypercalcemic crisis at presentation (odds ratio, 5.59; 95% confidence interval, 1.45-21.51; P = .012). Follow-up was shorter in group 1 patients (15 vs. 24 months; P < .001) and postoperative PTH levels were higher (76 vs. 48 pg/mL; P < .001). Other perioperative data were not different between the groups.

CONCLUSION:

Underinsured patients with HPT may present with higher serum calcium and PTH levels, are more likely to have hypercalcemic crisis, and less likely to return for follow-up. Underfunded health insurance coverage may account for differences seen in this study.

Copyright © 2012 Mosby, Inc. All rights reserved.

PMID:
22000828
[PubMed - indexed for MEDLINE]
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