Unique Considerations in the Older Patient Considering Surgical Management of Primary Hyperparathyroidism

/Abstract Primary hyperparathyroidism (PHPT) is a calcium metabolic disorder affecting nearly three million Americans, with a significant predominance in older adults. If left untreated, PHPT can lead to serious health complications, including fractures, neurocognitive decline, kidney stones, and kidney failure. While surgical parathyroidectomy (PTX) provides the only definitive cure, it remains underutilized, disproportionately so among the geriatric population. Various factors contribute to this underutilization of PTX in the geriatric population, including both perceived and actual risks of perioperative complications in older patients, competing medical priorities, under-recognition of the condition, and limited access to care. Current understanding of the risks associated with PTX in this demographic is superficial, lacking depth regarding the influence of frailty status and the unique priorities of older patients and their care teams in the decision-making process surrounding PTX. A critical barrier to enhancing surgical decision making for older patients with PHPT lies in the absence of detailed, personalized predictions of perioperative complications, as well as a lack of insight into the specific priorities of older patients and their healthcare providers. The overall objective of this proposed study is to improve surgical decision-making for older patients with PHPT through the development of personalized predictive models for PTX-related complications and by exploring the unique priorities and values that shape both patient and provider decision making. To achieve these objectives, two specific aims are outlined: 1) Develop predictive models for PTX-associated complications, leveraging age, frailty status, and relevant clinical characteristics within a large national cohort, and validate the models externally; and 2) Evaluate the unique priorities that influence older patients and their care teams when considering surgical management for PHPT. This research will yield validated models for predicting PTX-associated complications in older patients and will identify barriers and facilitators influencing surgical decision-making in this population, providing critical insights into the roles of patient and provider priorities and values. Ultimately, this work will enhance the alignment of care with the preferences and needs of older patients with PHPT, facilitating better health outcomes and more appropriate provision of care. Project Number: 1R03AG095804-01 | Fiscal Year: 2025 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Vivek Sant | Institution: UT SOUTHWESTERN MEDICAL CENTER, DALLAS, TX | Award Amount: $415,000 | Activity Code: R03 | Study Section: Special Emphasis Panel[ZAG1 ZIJ-I (M1)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11224925