确定甲状旁腺手术的时机是否会影响肾结石再治疗和心血管干预的风险。长期未经治疗的原发性甲状旁腺功能亢进症与包括肾结石和心血管疾病在内的显着发病率相关。我们在纽约和加利福尼亚州进行了一项基于人群的队列研究2000 年至 2020 年全州数据。接受肾结石治疗并随后诊断为原发性甲状旁腺功能亢进症（pHPT）并接受甲状旁腺切除术（PTX）的成年患者被纳入其中。如果患者在指数结石手术之前进行了 PTX、在 6 个月内接受了第二次结石治疗、患有 V 期 CKD、患有继发性或三发性甲状旁腺功能亢进症、既往接受过肾移植或血液透析、或者既往有癌症诊断，则被排除在外。测量了在指数结石手术后 ≤ 2 年和 > 2 年接受甲状旁腺手术的 pHPT 合并肾结石患者的 PTX 后肾结石再治疗和心血管干预的比率。我们确定了 2,093 名接受首次结石治疗和后续 PTX 的患者。 PTX 的中位时间为 560 天 (IQR 187-1477)，随访时间为 7.4 年 (IQR 4.5-13.1)。延迟 PTX 超过 2 年会使肾结石再治疗的风险增加 59%（HR 1.59；P<0.001），使发生冠心病或相关干预措施的风险增加 118%（HR=2.18；P=0.01），并且发生总体心血管事件的风险增加了 52%（HR 1.52；P<0.01）。在有症状的 pHPT 中，延迟 PTX 会显着增加未来需要再次结石治疗和心脏/血管手术干预的风险。这凸显了早期手术转诊和多学科方法对于优化 pHPT 的结果和资源利用的重要性。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions.Long-term, untreated primary hyperparathyroidism is associated with significant morbidity including nephrolithiasis and cardiovascular disease.We conducted a Population-based Cohort study of New York and California state-wide data from 2000-2020. Adult patients who underwent renal stone treatment and subsequently diagnosed with primary hyperparathyroidism (pHPT) and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was prior to index stone procedure, they underwent second stone treatment within 6 months, with stage V CKD, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. Rate of renal stone retreatment and cardiovascular interventions after PTX in pHPT patients with nephrolithiasis who underwent parathyroid surgery at ≤ 2 years and >2 years after index stone procedure was measured.We identified 2,093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (IQR 187-1477) and follow-up was 7.4 years (IQR 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR 1.59; P<0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P=0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR 1.52; P<0.01).In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.