Format

Send to

Choose Destination
J Am Coll Surg. 2019 Jan 21. pii: S1072-7515(19)30045-6. doi: 10.1016/j.jamcollsurg.2018.12.034. [Epub ahead of print]

Bilateral Neck Exploration for Sporadic Primary Hyperparathyroidism: Utilization Patterns in 5,597 Patients Undergoing Parathyroidectomy in the Collaborative Endocrine Surgery Quality Improvement Program.

Author information

1
Department of Surgical Oncology Section of Endocrine Surgery, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Surgery Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN.
2
Department of Surgery Section of Endocrine Surgery, Medical College of Wisconsin, Milwaukee, WI.
3
Department of Surgical Oncology Section of Endocrine Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
4
Department of Surgery Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: Carmen.solorzano@vumc.org.

Abstract

INTRO:

For many surgeons, focused parathyroidectomy has become the preferred approach for the management of sporadic primary hyperparathyroidism (HPT). This study describes utilization patterns of bilateral neck exploration (BE) by endocrine surgeons participating in the Collaborate Endocrine Surgery Quality Improvement Program (CESQIP).

METHODS:

Using the CESQIP parathyroid dataset (2014-2017), utilization trends, demographic and clinical characteristics of patients undergoing BE vs. focused vs. focused converted to BE parathyroidectomy were compared. Preoperative, intraoperative, and postoperative variables were also analyzed.

RESULTS:

Among 5,597 patients who underwent initial parathyroidectomy for HPT, BE was utilized in 2,253 (40%) of which 613 (11%) were converted procedures. Patients with BE were older and more likely female. Ultrasound (87%), Sestamibi (66%) and CT scans (20%) were commonly utilized. Glands were highly localized. Intraoperative-PTH (ioPTH) was used in >90%. Operative time >2hrs was more likely in BE (16%) and converted (30%) vs. focused (3%) procedures. Two or more glands were removed in 57% of BE cases. Outpatient procedures were more common in focused cases; ER visits, readmissions and complications were more likely in BE and converted cases. Concern for failure and lack of ioPTH decrease was significantly more common in BE and converted cases.

CONCLUSIONS:

This is the first analysis of parathyroidectomy utilization trends by high-volume endocrine surgeons in CESQIP. BE is a commonly utilized approach (40%) and conversion from focused to BE was observed in 11% of cases, despite highly-localized glands. BE remains a complex and frequently utilized procedure and surgeons intending to perform parathyroid surgery should be adequately trained and adept at BE.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center