title: Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy.
abstract: BACKGROUND
  Successful preoperative localization plays an important role in patient selection for focused parathyroidectomy.
  
  
  METHODS
  The case records of 499 consecutive patients with presumed hyperparathyroidism who underwent neck exploration were reviewed. Positive imaging patients (n = 373) had a localizing study that clearly showed a single abnormal parathyroid gland whereas negative imaging patients (n = 44) failed to localize or had discordant imaging results.
  
  
  RESULTS
  Positive imaging patients were more likely to have a single adenoma (93.0% vs 72.1%; P < .001), and were less likely to require a bilateral exploration (8.1% vs 70.4%; P < .001). Negative imaging patients required more frozen sections (.9 +/- 1.3 vs .2 +/- .7; P < .001), and longer surgical time (77.3 +/- 52.5 min vs 48.4 +/- 34.6 min; P < .001). The cure rate was significantly higher in the positive imaging group (96.0% vs 87.1%; P < .03), with no difference in the incidence of complications (3.2% vs 2.3%; P value was not significant).
  
  
  CONCLUSIONS
  Patients with unsuccessful or discordant preoperative localization have a higher incidence of multigland disease, lower cure rate, and consume more institutional resources than patients with successful preoperative localization.
authors.affiliation: Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
authors.forename: Avital
authors.initials: A
authors.lastname: Harari
authors.forename: John
authors.initials: J
authors.lastname: Allendorf
authors.forename: Alexander
authors.initials: A
authors.lastname: Shifrin
authors.forename: Mary
authors.initials: M
authors.lastname: DiGorgi
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care; D055815:Young Adult