{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:03:23Z","timestamp":1789704203773,"version":"4.0.1"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To revisit the current age criterion (50 years) for surgical candidacy in patients diagnosed with asymptomatic primary hyperparathyroidism (PHPT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A predictive model relying on past publications using the electronic databases \u201cPubMed,\u201d \u201cEmbase,\u201d \u201cMedline,\u201d\u00a0and \u201cGoogle Scholar.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hypothetical large cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov model was constructed, based on relevant literature, to compare 2 potential treatment algorithms for asymptomatic PHPT patients, parathyroidectomy (PTX), and observation. The various potential health states were characterized for the 2 treatment options and included potential surgical complications, end\u2010organ deterioration, and death. A 1\u2010way sensitivity analysis was performed to calculate the quality\u2010adjusted life year (QALY) gains of both strategies. A Monte\u2010Carlo simulation for 30,000 subjects was performed and cycled per annum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On the basis of the model's assumptions, the QALY value for the PTX strategy was 19.17 versus\u00a017.82 for the observation strategy. The incremental QALY gains for various ages according to the sensitivity analyses for PTX in comparison to observation were: 2.84 QALY for 40\u2010year\u2010old patients, 2.2 QALY for 50\u2010year\u2010old patients, 1.81 QALY for 55\u2010year\u2010old patients, 1.35 QALY for 60\u2010year\u2010old patients, and 0.86 QALY for 65\u2010year\u2010old patients. The incremental QALY is below 0.5 after the age of 75 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study found PTX to be advantageous for asymptomatic PHPT patients older than the current age criterion of 50 years. The calculated QALY gains support a surgical approach for medically fit patients in their 50s. The current guidelines for the surgical treatment of young asymptomatic PHPT patients should be revisited by the next steering committee.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.298","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T18:14:33Z","timestamp":1676657673000},"page":"309-316","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Revisiting Age Criterion for Surgery in Asymptomatic Primary Hyperparathyroidism"],"prefix":"10.1002","volume":"169","author":[{"given":"Gilad","family":"Horowitz","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery and Maxillofacial Surgery Tel\u2010Aviv Sourasky Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel\u2010Aviv University)  Tel\u2010Aviv 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