title: Compliance with recommendations on surgery for primary hyperparathyroidism-from guidelines to real practice: results from an Iberian survey.
abstract: OBJECTIVE
  Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes.
  
  
  METHODS
  An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions.
  
  
  RESULTS
  Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038).
  
  
  CONCLUSIONS
  Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Virgen de las Nieves University Hospital, Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain. jesusm.villar.sspa@juntadeandalucia.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar-Del-Moral
authors.affiliation: Endocrine Surgery Division, Department of Surgery, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Capela-Costa
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Virgen Macarena University Hospital, Avenida Doctor Fedriani, 3, 41009, Sevilla, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Jiménez-García
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Marqués de Valdecilla University Hospital, Avenida Valdecilla, s/n, 39008, Santander, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Casanova-Rituerto
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Santa María University Hospital, Avenida Professor Egas Moniz, 1600-190, Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Rocha
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Virgen del Rocío University Hospital, Avenida Manuel Siurot, s/n, 41013, Sevilla, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Martos-Martínez
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Cruces University Hospital, Plaza de Cruces, 12, 48903, Barakaldo, Spain.
authors.forename: Aitor
authors.initials: A
authors.lastname: de la Quintana-Basarrate
authors.affiliation: Head and Neck Surgery Service, Instituto Português de Oncologia (IPO) - Lisboa, R. Professor Lima Basto, 1099-023, Lisbon, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rosa-Santos
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Parc Taulí Hospital, Parc Taulí, 1, 08208, Sabadell, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Guirao-Garriga
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Princesa University Hospital, Calle de Diego de León, 62, 28006, Madrid, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Bravo-de-Lifante
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Clínic University Hospital, Carrer Villarroel, 170, 08036, Barcelona, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Vidal-Pérez
authors.affiliation: Endocrine Surgery Division, Department of Surgery, Santa Creu i Sant Pau University Hospital, Carrer de Sant Quintí, 89, 08026, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Moral-Duarte
authors.affiliation: Hospital Santo Antonio, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Polónia
mesh_terms: D019983:Guideline Adherence; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D016105:Parathyroidectomy; D018579:Patient Selection; D011174:Portugal; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Intraoperative adjuncts; Outcomes research; Parathyroidectomy; Preoperative workup; Primary hyperparathyroidism; Survey