title: Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study.
abstract: BACKGROUND
  There is ongoing debate about the effectiveness and safety of performing parathyroid surgery in low-volume community hospitals.
  
  
  METHODS
  Cases performed at community hospital by a group of 4 parathyroid surgeons (group 1) were reviewed. Cure and complication rates were analyzed in light of outcomes of an expert endocrine surgeon from high-volume academic center (group 2) as point of reference.
  
  
  RESULTS
  During the respective time periods, 204 patients met inclusion criteria in group1 and 218 patients in group 2. Patient characteristics, biochemical tests, and performed localizing studies (ultrasound and sestamibi scan) were comparable between the two groups. Pathological findings, including adenoma, double adenoma, hyperplasia, and cancer were comparable. Each had comparable cure rates (97% and 99%) (p < 0.18) and complication rates (1% and 1%) (p < 0.93) for group 1 and 2, respectively.
  
  
  CONCLUSIONS
  Our results showed that experienced parathyroid surgeons will achieve comparable excellent outcomes of parathyroid surgery at both community and academic-based centers. As the field of endocrine surgery evolves and matures, producing young fellowship-trained endocrine surgeons, there will be growing need for expanding the niche of endocrine surgery into community-based hospital settings, which eventually will contribute to expanding and equalizing access to high-quality surgical care across urban and rural areas.
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA; Department of Surgery, "Alexandrovska" Hospital, Medical University of Sofia, 1 St. G. Sofiyski Blvd, Sofia 1431, Bulgaria.
authors.forename: Vladimir K
authors.initials: VK
authors.lastname: Neychev
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Maher
authors.initials: M
authors.lastname: Ghanem
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Blackwood
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Aragon Han
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Roghayeh
authors.initials: R
authors.lastname: Fazeli
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Schneider
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Najafian
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA.
authors.forename: Dov C
authors.initials: DC
authors.lastname: Bloch
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Bard
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Klarsfeld
authors.affiliation: Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
authors.affiliation: Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA. Electronic address: richard.lipton@wchn.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lipton
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D002983:Clinical Competence; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: Community hospitals; Experienced parathyroid surgeons; Parathyroid surgery