title: Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy.
abstract: BACKGROUND
  This study compared reoperative complication rates after initial minimally invasive parathyroidectomy and standard cervical exploration.
  
  
  METHODS
  Records from patients who underwent 1 reoperative parathyroidectomy at a single institution (1998 to 2012) were retrospectively reviewed.
  
  
  RESULTS
  Seventy-seven patients were included; 74% underwent initial standard cervical exploration. Preoperative and operative characteristics were similar between groups; 74% underwent focused, unilateral reoperation. A significantly higher rate of postoperative complications occurred in the initial standard cervical exploration group (42% vs 15%, P = .03) that could not be explained by differences in the rates of symptomatic hypocalcemia (P = .5). The type of prior parathyroidectomy was significantly associated with postoperative complications (odds ratio 4.1, 95% confidence interval 1.1 to 15.7, P = .04). In a multivariable logistic regression model that included body mass index, type of operation (for initial and reoperation), and initial operation performed prereferral as covariates, type of prior parathyroidectomy remained a significant predictor of postoperative complications.
  
  
  CONCLUSIONS
  Higher rates of postoperative sequelae after initial standard cervical exploration should be considered before performing routine 4-gland exploration.
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Lilah F
authors.initials: LF
authors.lastname: Morris
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Sukhyung
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Warneke
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Shabir S
authors.initials: SS
authors.lastname: Abadin
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Suliburk
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Minerva A
authors.initials: MA
authors.lastname: Romero Arenas
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Grubbs
authors.affiliation: Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA. Electronic address: NPerrier@mdanderson.org.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D016015:Logistic Models; D019060:Minimally Invasive Surgical Procedures; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Minimally invasive parathyroidectomy; Persistent or recurrent hyperparathyroidism; Primary hyperparathyroidism; Reoperative parathyroidectomy; Standard cervical exploration