Outcomes in patients with and without intraoperative parathyroid hormone testing for primary hyperparathyroidism: A retrospective observational analysis

Abstract

ObjectivesThe use of intraoperative parathyroid hormone (ioPTH) monitoring has been recommended as an adjunct to improve likelihood of successful parathyroid surgery. We sought to compare the surgical outcomes as well as operative times and associated costs in patients with and without ioPTH in the setting of co-localizing studies for primary hyperparathyroidism. MethodsA retrospective review was conducted of patients undergoing surgery for nonfamilial primary hyperparathyroidism at a single institution from January 2013 to April 2019. Patients with a suspected single adenoma that co-localized on sestamibi and ultrasound were included resulting in 141 patients, of which 110 (78%) had ioPTH testing (group 1) while 31 (22%) did not (group 2). Time driven activity-based cost (TDABC) analysis was performed incorporating physician and staff compensation and anesthetic usage to determine the cost differential between groups. Study DesignRetrospective chart review. ResultsIn group 1, the use of ioPTH prompted re-exploration in 2 patients (1.8%). In both cases, the initial gland identified was normal parathyroid and persistent elevation of ioPTH resulted in additional dissection and removal of the adenoma. All but two group 1 patients had normal post-operative calcium levels at last follow up for an overall success rate of 97.3%. One group 2 patient (3.2%) was found to have recurrent hyperparathyroidism 33 months later with an adenoma identified in the same location as the initial excision. Otherwise all group 2 patients were eucalcemic at last follow-up for an overall success rate of 96.8%. The average time for the procedure in group 1 was 91.7 ± 28.1 minutes compared to 52.3 ± 16.9 minutes in group 2 (p<0.001). Mean TDABC for group 1 was $900.93 ± 261.49 compared to $487.52 ± 157.93 for group 2 (p<0.001). ConclusionsIn patients with co-localizing sestamibi scan and ultrasound and concordant operative findings, the use of ioPTH did not improve the success rate of minimally invasive parathyroid surgery, while increasing operative times and cost.