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Surgery. 1999 Dec;126(6):1036-40; discussion 1040-1.

Is sestamibi-guided parathyroidectomy really cost-effective?

Author information

1
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Mass. 02215, USA.

Abstract

BACKGROUND:

Sestamibi-guided limited neck explorations are an alternative to the standard bilateral neck exploration for patients with primary hyperparathyroidism. A recently published meta-analysis by Denham and Norman (JACS vol.186, 1998) suggested that a sestamibi-directed approach offers a cost benefit because it decreases operative and recovery room times, hospital stay, and the number of frozen sections needed.

METHODS:

We reviewed 41 bilateral neck explorations for primary hyperparathyroidism and compared our results with those reported by the meta-analysis to determine whether a sestamibi-directed approach is cost effective.

RESULTS:

Operative and recovery room times averaged 60.3 +/- 19.3 and 45 minutes, respectively. Forty six percent of the patients were treated as outpatients, and 1.21 +/- 0.57 frozen sections were obtained per case. Our standard bilateral exploration cost 47% less than the bilateral approach and 17% less than the sestamibi-directed operation calculated in the meta-analysis. There were no cases of nerve injury or permanent hypocalcemia, 98% of patients were cured, and 61% of patients did not require narcotics postoperatively.

CONCLUSIONS:

Sestamibi-guided parathyroidectomy may not offer any advantage over the standard bilateral exploration. In our experience, a bilateral neck exploration can be performed on an outpatient basis and at low cost, with a high success rate and minimal morbidity. Most patients do not require narcotics, and the cosmetic results are excellent.

PMID:
10598185
[Indexed for MEDLINE]

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