Estimating complications and mortality in patients with post-surgical chronic hypoparathyroidism in England: A retrospective matched cohort study

Background

The clinical burden of post-surgical chronic hypoparathyroidism (HypoPT) in England is not well established. This study compared the risks of complications and mortality between patients with post-surgical chronic HypoPT and patients without HypoPT in England.

Methods

This retrospective, matched cohort study was conducted using linked data from Clinical Practice Research Datalink Aurum, Hospital Episode Statistics, and Office for National Statistics death registrations. The study period was 2007–2020. Patients with post-surgical chronic HypoPT were matched on age, gender, and primary care registration time to patients without HypoPT. Cox proportional hazards regression models were used to compare the risks of complications and mortality between patient groups. Regression models were adjusted for potential confounding variables where possible.

Results

The study included 215 patients with post-surgical chronic HypoPT (median follow-up 4.5 years) and 2149 patients without HypoPT (median follow-up 5.2 years). Compared to patients without HypoPT, patients with post-surgical chronic HypoPT had higher adjusted risks of mortality (adjusted hazard ratio [HR] 2.89, 95% confidence interval [CI] 1.85–4.51, p<0.001) and composite renal complications (adjusted HR 4.10, 95% CI 2.25–7.46, p<0.001). Patients with post-surgical chronic HypoPT also had higher unadjusted risks of cardiovascular complications, cataracts, infection, mental health complications, seizure, symptomatic hypocalcaemia, and symptomatic hypercalcaemia than patients without HypoPT.

Conclusions

In England, patients with post-surgical chronic HypoPT had a three-fold increased risk of mortality and a four-fold increased risk of renal complications compared to patients without HypoPT. Novel treatments for HypoPT are needed to reduce this clinical burden.