Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients.
OBJECTIVE
Preoperative localization procedures and the use of intraoperative parathyroidism (iOPTH) have led to a shift of paradigm from bilateral neck exploration to focused parathyroidectomy in primary hyperparathyroidism (pHPT). However, only a small number of randomized trials from specialized centers have been published. The main purpose of the study was to analyze the impact of localization procedures and iOPTH on short-term outcome after pHPT surgery in a multi-institutional setting.


METHODS
An audit for quality assurance in pHPT surgery was performed in 23 Scandinavian departments in 2004-2008. Data were gathered prospectively in a database. Two thousand seven hundred and eight patients were registered and 78% were females. The median serum calcium level was 2.79 mmol/l.


RESULTS
Localization procedures were performed in 1,831 patients (68%), (sestamibi in 54% and ultrasound in 41%) and iOPTH in 792 operations (29%). Bilateral exploration was performed in 61%, focused parathyroidectomy in 17%, and unilateral exploration in 22%. Histology showed parathyroid adenoma in 82%, with the median weight of 0.6 g. The alleviation of hypercalcemia at the first follow-up was 93% (94% for primary operation). In the multivariate logistic regression analysis, iOPTH increased cure rate (OR 1.70, 95% CI 1.14-2.53, p = 0.0092). The risk for postoperative medically treated hypocalcemia decreased with the use of localization procedures (OR 0.56, 95% CI 0.43-0.78, p = 0.0004) and iOPTH (OR 0.56, 95% CI 0.39-0.90, p = 0.0015).


CONCLUSIONS
Localization procedures and iOPTH decreased the risk for hypocalcemia after pHPT surgery. Additionally, iOPTH influenced short-term cure rate favorably.
Bergenfelz
Anders O J
AO
Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden. anders.bergenfelz@med.lu.se
Jansson
Svante K G
SK
Wallin
Göran K
GK
Mårtensson
Hans G
HG
Rasmussen
Lars
L
Eriksson
Håkan L O
HL
Reihnér
Eva I M
EI
D000236:Adenoma / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone; D010282:Parathyroid Neoplasms / Q000175:diagnosis; D016105:Parathyroidectomy / Q000379:methods; D011859:Radiography; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
D010281:Parathyroid Hormone; D002118:Calcium