Age-specific differences in parathyroidectomy after implementation of guidelines for primary hyperparathyroidism

Background: Despite meeting guideline-based criteria for surgery, older adults with primary hyperparathyroidism (PHPT) undergo parathyroidectomy at lower rates. We aimed to evaluate age-specific differences in PHPT diagnosis, time to surgery, and surgical indications among patients offered parathyroidectomy. Methods: Retrospective cohort study of adults with sporadic PHPT who underwent parathyroidectomy between 1/1/2017 and 12/31/2022 at a tertiary academic center was performed. Surgical indications were determined using the 2016 American Association of Endocrine Surgeons (AAES) and Fourth International Workshop guidelines. Complete preoperative evaluation was defined as documentation of corrected serum calcium, parathyroid hormone (PTH), 25-hydroxy vitamin D, estimated glomerular filtration rate (eGFR), bone imaging/dual-energy X-ray absorptiometry (DXA), and 24-hour urine calcium. Results: Among 266 patients (median age 63.2 years; 74.8% female), 145 (54.5%) were