title: Is sestamibi-guided parathyroidectomy really cost-effective?
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.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Mass. 02215, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Greene
authors.forename: P
authors.initials: P
authors.lastname: Mowschenson
authors.forename: R A
authors.initials: RA
authors.lastname: Hodin
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D005629:Frozen Sections / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery*; D016105:Parathyroidectomy / Q000191:economics* / Q000379:methods; D017060:Patient Satisfaction; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi / Q000191:economics*
chemical_list: D017256:Technetium Tc 99m Sestamibi