Operative failures after parathyroidectomy for hyperparathyroidism: the influence of surgical volume.
OBJECTIVE
To determine whether surgical volume influences the cause of operative failures after parathyroidectomy for hyperparathyroidism.


BACKGROUND
The surgical success rate for hyperparathyroidism from high-volume centers exceeds 95%, but some patients have unsuccessful parathyroidectomies. Although operative failure can be due to hyperfunctioning parathyroid glands in ectopic locations, less experienced surgeons may be more likely to miss an abnormal parathyroid in normal anatomic locations, which we describe as "preventable operative failure."


METHODS
We used 2 prospective databases containing over 2000 consecutive patients who underwent parathyroidectomy. We identified 159 patients with persistent/recurrent hyperparathyroidism subsequently cured with additional surgery. The initially failed operations were classified as being performed at high- (>50 cases/yr) or low-volume (<50 cases/yr) hospitals. Hospital volume was obtained from a Wisconsin state database of 89 hospitals, which reported 6336 parathyroid operations during the same decade.


RESULTS
Patients who initially failed their operation performed at the high- or low-volume centers were similar with regard to age, laboratory values, gender, and parathyroid weights. Despite a higher incidence of multigland disease (which increases the likelihood of operative failure) in the high-volume group, patients in the low-volume group were more likely to have a missed parathyroid gland in a normal anatomic location (89% vs. 13%, P < 0.0001), and thus a higher proportion of preventable operative failures.


CONCLUSIONS
Surgical volume influences the failure pattern after parathyroidectomy for hyperparathyroidism. Preventable operative failures are more common in low-volume centers.
Chen
Herbert
H
Department of Surgery, University of Wisconsin, Madison, WI 53792, USA. chen@surgery.wisc.edu
Wang
Tracy S
TS
Yen
Tina W F
TW
Doffek
Kara
K
Krzywda
Elizabeth
E
Schaefer
Sarah
S
Sippel
Rebecca S
RS
Wilson
Stuart D
SD
D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D017211:Treatment Failure; D014922:Wisconsin; D016526:Workload / Q000706:statistics & numerical data