title: Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism.
abstract: BACKGROUND
  Many adjuncts guide surgical decision making in parathyroidectomy, yet their independent associations with outcome are poorly characterized. We examined a broad range of perioperative factors and used multivariate techniques to identify independent predictors of operative failure (persistent disease) after parathyroidectomy.
  
  
  METHODS
  This was a retrospective review of 2239 patients with primary hyperparathyroidism who underwent parathyroidectomy at a single-center from 1999 to 2014. We used multivariate logistic regress to measure associations between multiple perioperative factors and an operative failure (persistent hypercalcemia).
  
  
  RESULTS
  Operative failure was identified in 67 patients (3.0%). The following variables were independently associated with operative failure on multivariate analysis: IOPTH criteria met (protective, OR = 0.22, P < 0.001), preoperative calcium (risk factor, OR = 2.27 per unit increase, P < 0.001), weight of excised gland(s) (protective, OR = 0.70 per two-fold increase, P = 0.003), and preoperative PTH (protective, OR = 0.55 per two-fold increase, P = 0.008).
  
  
  CONCLUSIONS
  In addition to the well-established IOPTH criteria, we suggest that consideration of the above independent perioperative risk factors may further inform surgical decision-making in parathyroidectomy.
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: dcron@med.umich.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Cron
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: skapeles@med.umich.edu.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Kapeles
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: eandras@med.umich.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Andraska
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: stkwon@med.umich.edu.
authors.forename: Sebastian T
authors.initials: ST
authors.lastname: Kwon
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: pkirk@med.umich.edu.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Kirk
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: mcneishb@med.umich.edu.
authors.forename: Brendan L
authors.initials: BL
authors.lastname: McNeish
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: cleeho@umich.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: davhughe@med.umich.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Hughes
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
keywords: Operative failure; Parathyroidectomy; Persistent hypercalcemia; Primary hyperparathyroidism