Parathyroidectomy For Primary Hyperparathyroidism Research Articles

Actigraphy measures show sleep improvement after parathyroidectomy for primary hyperparathyroidism

ImportanceThe symptoms of primary hyperparathyroidism are often subtle, such as fatigue, mood changes, and sleep disturbances. After parathyroidectomy, patients often report improvement in sleep and mood; however, objective data supporting these improvements is lacking. ObjectiveThis prospective study uses standard measures to objectively and subjectively assess sleep in patients with primary hyperparathyroidism before and after parathyroidectomy. DesignA longitudinal prospective study was conducted over three one-week-long periods: pre-parathyroidectomy, 1-week post-parathyroidectomy, and three months post-parathyroidectomy. During each time point, patients wore an actigraphy device, recorded a sleep diary, and completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scale (DASS). Statistical analysis was performed using repeated measures models to compare the average measures among the three time points and test for trends over time. SettingSingle institution, tertiary care center. ParticipantsPatients with primary hyperparathyroidism from ages 18 to 89 years old. ExposureParathyroidectomy between September 2020 and January 2024. Main outcomes and measuresActigraphy data, consensus sleep diary, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Depression Anxiety Stress Scales – 21 Items (DASS). ResultsThirty-six patients were enrolled, and 34 patients completed the study. Actigraphy data showed a significant negative trend in average sleep latency (p = 0.045) and average time in bed (p = 0.046). Sleep diary data showed additional differences in the number of awakenings (p = 0.002), wake after sleep onset (p < 0.001), sleep quality (p < 0.001), and sleep efficiency (p = 0.02) among the three time points and/or as a significant negative trend. PSQI and ISI scores were significantly different among the three time points (p = 0.002 and p < 0.001, respectively) and also declined significantly over time (p = 0.008 and p = 0.007, respectively). DASS depression, anxiety, and stress scores were significantly different among the three time points (p < 0.001, p = 0.01, and p < 0.001, respectively), and stress also declined significantly over time (p = 0.005). Conclusion and relevanceThis study represents the most extensive prospective study demonstrating objective and subjective sleep and mood improvement in patients with primary hyperparathyroidism after parathyroidectomy.

Intraoperative radio-guided localization of parathyroid adenomas using 3D freehand SPECT technology.

Parathyroidectomy for primary hyperparathyroidism (PHPT) could have poor outcomes, even with accurate preoperative localization of the adenomas, because their intraoperative localization can be challenging. Freehand single photon emission computed tomography (fhSPECT) is a new technique for radio-guided intraoperative navigation. Its use during parathyroidectomy could be useful and such data are limited. We herein present our experience on the feasibility of fhSPECT for intraoperative detection of abnormal parathyroid glands. We retrospectively reviewed the clinical data of 55 patients (30-77years old) with PHPT due to parathyroid adenomas, that were subjected to parathyroidectomy from 12/2017 to 7/2022. In average, 111 ± 74MBq of Tc-99m Sestamibi were injected intravenously, approximately 2h before the operation and fhSPECT was used to generate 3D images during parathyroidectomy. Measurements of PTH and calcium levels were performed preoperatively, postoperatively and 4-6months after the procedure. FhSPECT successfully identified the parathyroid adenoma in all the patients. It took 3min (median time) for fhSPECT to detect at least one radioactive spot in all patients. The mean duration of the operation was 66.6 ± 7.3min. Forty-nine patients out of 55 had solitary and 6/55 had multiple adenomas, whereas 6/55 had ectopic abnormal parathyroid glands. None of the patients had persistent hyperparathyroidism during follow-up. To the best of our knowledge, this is the largest series of patients with PHPT that underwent fhSPECT assisted parathyroidectomy. Our data suggest that this navigation system is helpful in identifying parathyroid adenomas intraoperatively.

PHQ-9 and GAD-7 Score Response After Parathyroidectomy for Primary Hyperparathyroidism: a Systematic Review and Meta-analysis.

Currently, the relationship between parathyroidectomy and objective neuropsychiatric outcomes are not clearly defined. The purpose of this study is to perform the first ever Meta-analysis of preoperative and postoperative PHQ-9 and GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy with the goal of identifying a specific psychometric score that could be used as an indication for surgical intervention. A comprehensive search of the literature was performed using PubMed, Embase, PsycINFO, Web of Science, and Ovid All EBM Reviews. Studies met inclusion criteria if they evaluated preoperative and postoperative PHQ-9 and/or GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy. Random effects Meta-analyses were used to analyze the compiled data. The literature search returned 1433 articles for initial review of which 6 (1105 participants) met criteria for inclusion and Meta-analysis. Meta-analysis revealed that primary hyperparathyroidism patients had significantly higher presurgical PHQ-9 scores when compared to control groups. Additionally, patients experienced a statistically significant and sustained decrease in PHQ-9 scores following parathyroidectomy. Notably, there was a dramatic decrease in the percentage of patients with PHQ-9 scores ≥10 (considered clinically significant for depression) following parathyroidectomy. Patients with primary hyperparathyroidism experience a statistically significant and sustained improvement in PHQ-9 scores following parathyroidectomy. Additionally, symptoms of anxiety and suicidal ideation appear to decrease after parathyroidectomy. We propose that a PHQ-9 score ≥10 could potentially be used as an indication for parathyroidectomy in patients with asymptomatic primary hyperparathyroidism.

Surgery for nonlocalizing hyperparathyroidism in high volume center.

Patients with nonlocalizing hyperparathyroidism pose a significant challenge to surgeons when undergoing neck exploration for parathyroidectomy. We evaluated 536 patients that had parathyroidectomy for primary hyperparathyroidism (PHPT) from 2005 to 2018 at a single tertiary academic center, and 155 (29%) had standard nonlocalizing preoperative imaging (negative ultrasound and sestamibi scans). There were a total of 102 (66%) non-ectopic single adenomas in the nonlocalizing group and 325 (85%) single adenomas in the localizing group. There was no significant difference (p = 0.09) in adenoma quadrant between localizing and nonlocalizing single adenomas, but the most common location in both groups was right inferior. Patients with nonlocalizing scans were more likely to have double adenomas (21% vs. 9%, p < 0.001), ectopic glands (10% vs. 5%, p = 0.052), and multi-gland disease (13% vs. 8%, p = 0.002). Nonlocalizing PHPT patients experienced similar cure and complication rates as localizing PHPT, but required more bilateral explorations and increased operative time.

A commentary on "Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years - a prospective cohort study".

A commentary on "Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years - a prospective cohort study".

Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy.

Our retrospective database study investigatessex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS 1day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion,predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resourceutilization. Level of Evidence: IV. The online version contains supplementary material available at 10.1007/s12070-023-04444-3.

Parathyroidectomy Improves Bone Density in Women With Primary Hyperparathyroidism and Preoperative Osteopenia.

Osteoporosis and/or bone fractures are indications of parathyroidectomy in primary hyperparathyroidism (PHPT), especially in women. However, the benefit of surgery in patients with osteopenia remains unclear. To evaluate bone mineral density (BMD) and bone remodeling biomarkers changes 1 year after parathyroidectomy in women with PHPT. In the prospective, monocentric, observational prospective cohort with primary hyperparathyroidism patients (CoHPT) cohort, women operated for sporadic PHPT since 2016 with ≥1 year follow-up were included. BMD (dual-X ray absorptiometry) and bone remodeling biomarkers [cross-linked C-telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and bone-specific alkaline phosphatases] were assessed before and 1 year after parathyroidectomy. Referral center. A total of 177 women with PHPT (62.5 ± 13.3 years, 83.1% menopausal, 43.9% osteopenic, and 45.1% osteoporotic) were included. Parathyroidectomy. BMD change between before and 1 year after parathyroidectomy. Parathyroidectomy resulted in significant increase in BMD and decrease in serum bone remodeling biomarker concentrations. In the 72 patients with baseline osteopenia, mean BMD significantly increased at the lumbar spine [+0.05 g/cm2 (95% confidence interval [CI], 0.03-0.07)], the femoral neck [+0.02 g/cm2 (95% CI 0.00-0.04)], the total hip [+0.02 g/cm2 (95% CI 0.01-0.02)], and the forearm [+0.01 (95% CI 0.00-0.02)], comparable to osteoporotic patients. Among osteopenic patients, those with individual BMD gain (>0.03 g/cm2) at ≥1 site had higher preoperative serum CTX, P1NP, and urine calcium concentrations than those without improvement. Parathyroidectomy significantly improved BMD and remodeling biomarkers in women with osteopenia, thereby supporting the benefit of parathyroidectomy in these patients. Preoperative serum CTX and P1NP concentrations could be useful to predict expected BMD gain.

Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review.

Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities.

A commentary on 'The role of rapid intraoperative parathyroid hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis'.

A commentary on 'The role of rapid intraoperative parathyroid hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: A systematic review and meta-analysis'.

Patients with prediabetes improve insulin resistance after surgery for primary hyperparathyroidism

BackgroundThe objective of this study was to evaluate the evolution of insulin resistance at 12 months after parathyroidectomy for primary hyperparathyroidism according to the preoperative severity of glucose metabolism abnormalities. MethodsObservational study of patients who underwent parathyroidectomy between 2016 and 2021. Prediabetes and insulin resistance were defined as fasting glucose ≥1.00 g/L (American Diabetes Association) and homeostatic model assessment of insulin resistance >2.5, respectively. ResultsA total of 231 patients were included. Preoperatively, 75 patients (32%) had prediabetes, and 108 patients (47%) had insulin resistance. At 12 months postoperative, homeostatic model assessment of insulin resistance values significantly decreased in patients with prediabetes (–0.69; P = .04) and in patients with insulin resistance (–0.85; P < .001). In patients with prediabetes, 48/75 (64%) decreased their insulin resistance, including 15/48 (31%) with normalization of fasting glucose. In multivariate analysis, preoperative prediabetes (1.82, 1.03–3.21; P = .037) or preoperative homeostatic model assessment of insulin resistance >2.5 (3.90, 2.23–6.75; P < .001) remained independent predictors for insulin resistance reduction observed between preoperative and 12 months postoperative. ConclusionParathyroidectomy is more likely to reduce insulin resistance in patients with primary hyperparathyroidism and prediabetes or in patients with higher preoperative homeostatic model assessment of insulin resistance values. These data support the use of the preoperative prediabetes criterion in addition to the international workshop criteria for parathyroidectomy to better select patients for surgery.

Do men improve their bone mineral density 1 year after parathyroidectomy for primary hyperparathyroidism? Results of a prospective study

BackgroundThe impact of parathyroidectomy on bone mineral density in men with primary hyperparathyroidism is poorly known. This study aimed to evaluate the bone mineral density and bone remodeling biomarker changes in men with primary hyperparathyroidism 1 year after parathyroidectomy. MethodsMen operated for sporadic primary hyperparathyroidism between 2016 and 2022, enrolled in a monocentric prospective cohort, were analyzed. Patients with follow-up <1 year or missing data were excluded. Bone mineral density (dual X-ray absorptiometry) was measured before and 12 months after parathyroidectomy. Bone mineral density change ≥0.03g/cm2 was deemed significant. Bone remodeling biomarkers were serum cross-linked C-telopeptide, procollagen type 1 N-terminal propeptide, and bone-specific alkaline phosphatases. ResultsForty-five men were included (mean age 58.8 ± 13.1 years). Before surgery, 49% had osteopenia, and 11% had osteoporosis. Mean serum calcium and median serum parathyroid hormone levels decreased significantly after surgery (P < .0001). One year after parathyroidectomy, the mean bone mineral density increased significantly at the lumbar spine (+0.04g/cm2 [0.01;0.70], P = .0054), femoral neck (+0.04g/cm2 [0.03;0.05], P < .0001) and total hip (+0.02g/cm2 [0.01;0.03], P = .0002). Considering significant bone mineral density gain (+1 point) and loss (–1 point) at each site, 29/45 patients (64% [95% CI 49;78]) improved. Bone remodeling biomarker concentrations significantly decreased (P < .001). ConclusionParathyroidectomy positively affects bone mineral density in men with primary hyperparathyroidism, supporting osteopenia as a surgical indication in these patients.

Long-term Survival Following Parathyroidectomy for Primary Hyperparathyroidism in Elderly People with Polypharmacy

Long-term Survival Following Parathyroidectomy for Primary Hyperparathyroidism in Elderly People with Polypharmacy

FRI700 Adverse Events In Patients With Primary Hyperparathyroidism With And Without Successful Parathyroidectomy - A Propensity-matched Comparison

Abstract Disclosure: J. Han: None. Y. Yuan: None. J. Hu: None. C. Ghosh: None. E. Kebebew: None. Objective: The aim of the study was to evaluate the impact of successful parathyroidectomy on renal, skeletal and cardiovascular adverse events in patients with primary hyperparathyroidism (PHPT). Background: PHPT may be associated with renal, skeletal and cardiovascular diseases. In some but not all studies, successful parathyroidectomy has been reported to be associated with reduced risks of renal, skeletal or cardiovascular adverse events. To date, there has not been a comprehensive study with granular data looking at the impact of parathyroidectomy on all adverse events that have been associated with PHPT. Methods: A health system cohort study was performed in 3,048 patients with PHPT as defined by ICD10 or ICD9 codes who had successful parathyroidectomy defined by CPT codes (n=1,105) and no parathyroidectomy (n=1943). Comparison of cardiovascular (arrhythmias, myocardial infarction, congestive heart failure, cardiac admission, hypertension, diabetes mellitus), renal (kidney stone, end-stage renal disease requiring dialysis, GFR &amp;lt; 30 mL/min) and skeletal (all fractures, fragility fractures (hip/pelvis and spinal fractures), diagnosis of osteoporosis or osteopenia) adverse events by parathyroidectomy status (successful vs. no parathyroidectomy) in unmatched and basic matched analyses, and propensity score (PS) matched analysis at 10 years of follow up. Results: The mean age was higher in the no parathyroidectomy arm. The comorbidity score was higher (4.1 vs 3.6) in patients who did not have parathyroidectomy with higher rates of congestive heart failure and myocardial infarction at baseline. Patients who had parathyroidectomy had a lower rate of subsequent diagnosis of cardiovascular adverse events at 10 years of follow up (OR 0.57, p&amp;lt;0.001). There was also a lower odds of death at 10 years in those who had successful parathyroidectomy (OR 0.29, p&amp;lt;0.001). These differences were significant in the unmatched and basic matched analyses, but were not significant after PS matching. There was no significant difference in 10 years rates of any fractures , fragility fractures, or renal adverse events. The odds of diagnosis of osteoporosis or osteopenia at 10 years of follow up was significantly lower in patients who had successful parathyroidectomy in all 3 analyses (PS-matching: OR 0.507, p&amp;lt;0.001). Conclusions: Compared to patients who did not have parathyroidectomy for PHPT, patients who had successful parathyroidectomy have lower 10 years rates of osteoporosis/osteopenia diagnoses. Cardiovascular adverse events were lower in patients who had successful parathyroidectomy but this may be due to higher baseline comorbidities in those who did not have parathyroidectomy. Presentation: Friday, June 16, 2023

SAT183 What Determines Bone Mineral Density Changes After Successful Parathyroidectomy In Primary Hyperparathyroidism?

Abstract Disclosure: J.E. Mosquera: None. X. Li: None. N. Maalouf: None. Background: Parathyroidectomy (PTX) is the only cure for primary hyperparathyroidism (PHPT). However, the impact of PTX on bone mineral density (BMD) is very variable. Methods: To assess the impact of demographic and clinical characteristics on BMD change post-PTX, we retrospectively reviewed charts of patients with biochemically proven PHPT and successful PTX between 2006 and 2022 at our institution and who had available pre- and post-PTX DXA scans. We extracted available demographic, clinical, and laboratory data including age, gender, race, body mass index, pre-PTX serum parathyroid hormone, calcium, phosphorus, alkaline phosphatase (Alkphos), 25-OH-vitamin D, and creatinine, 24-hour urine calcium, and use of bisphosphonates. The association between these parameters and BMD changes were assessed using univariate and multivariate models. Results: 121 patients (107 women) were included in this analysis. 35% were African American and 50% Hispanic. At PTX, mean (SD) age was 59 (12) years, BMI was 33 (7) kg/m2. 36% had osteopenia and 47% had osteoporosis on pre-PTX DXA. 6% of patients used BP before PTX and 3% used BP within one year of PTX. At year 1 post-PTX, median BMD (25th-75th percentile) change was +2.7% (-0.2% - +6.6%) at the lumbar spine (LS), +2.4% (-0.5% - +5.9%) at the femoral neck (FN), +2.8% (0.7% - +4.7%) at total hip (TH), and +0.1% (-3.6% - +3.0%) at the 1/3 radius. In univariate analyses, 1-year change in FN BMD was positively associated with highest pre-PTX serum calcium, PTH, and Alkphos, and negatively associated with age and serum creatinine. TH BMD change at 1 year was positively associated with highest pre-PTX PTH and Alkphos, and negatively associated with lowest T-score at baseline, age, and pre-PTX serum phosphorus, 25-OH-D and creatinine. LS BMD change at 1 year was positively associated with highest pre-PTX serum calcium and PTH, and negatively associated with lowest phosphorus pre-PTX. In multivariate analyses, younger age, highest pre-PTX serum calcium, and lowest BMD T-score pre-PTX were all independently and significantly associated with greater increase in post-PTX BMD at the FN, TH, and LS. Moreover, pre-PTX Alkphos was associated with greater BMD gain at the FN and TH, while female gender was associated with greater gain in LS BMD. Conclusions: In patients with PHPT who undergo curative PTX, variable BMD changes are observed at 1-year post-PTX. Younger age at PTX, higher serum calcium, and lower BMD pre-PTX are all associated with greater BMD gains post-PTX. These findings should be considered in the counseling of PHPT patients undergoing PTX. Presentation: Saturday, June 17, 2023

Primary hyperparathyroidism: clinical manifestations, diagnosis and evaluation according to the Fifth International Workshop guidelines.

Primary hyperparathyroidism (PHPT) is a frequent endocrine disease which mainly affects the skeletal system and kidney. Some of its signs and symptoms are similar to those seen in rheumatic diseases such as rheumatoid arthritis, Sjögren's disease, fibromyalgia, polymyalgia rheumatica, gout or systemic lupus erythematosus. Coexistence of primary hyperparathyroidism with those pathologies potentiate their effects on muscles, bones and joints, increasing the risk of complications such as osteoporosis and fractures. Therefore, rheumatologists should be familiar with symptoms and diagnostic criteria of PHPT and consider it in the differential diagnosis of rheumatic diseases. In 2022 the Fifth International Workshop guidelines on the PHPT evaluation and management were published. They are based on a profound analysis of advances in research concerning multiple fields, that include genetics, outcomes and new imaging modalities of PHPT. They have led to revision of previous renal indications for parathyroidectomy in PHPT. There is also more evidence for the other recommendations regarding evaluation of the disease. This article summarizes the most relevant elements of these recommendations and refers them to Polish realities. I focus on the symptoms of primary hyperparathyroidism and its diagnosis as I consider these areas to be the most important for non-endocrinologists.

Disparities in Parathyroidectomy: Who Receives Appropriate Treatment for Primary Hyperparathyroidism?

IntroductionParathyroidectomy is underperformed despite clear benefits in primary hyperparathyroidism (PHPT). We evaluated disparities in receipt of parathyroidectomy following PHPT diagnosis to explore barriers to care. MethodsAdults diagnosed with PHPT 2013-2018 at a health system were identified. Recommended indications for parathyroidectomy include age ≤50 y, calcium >11 mg/dL, or the presence of nephrolithiasis, hypercalciuria, nephrocalcinosis, decreased glomerular filtration rate, osteopenia, osteoporosis, or pathological fracture 1 y prior to diagnosis. Kaplan–Meier analysis assessed rates of parathyroidectomy within 12 mo following diagnosis as well as median time to parathyroidectomy, and multivariable Cox proportional hazards analyses assessed factors associated with undergoing parathyroidectomy. ResultsOf 2409 patients, 75% were females, 12% aged ≤50 y, and 92% non-Hispanic White, while 52% had Medicaid/Medicare, 36% were commercial/self-pay or uninsured, and 12% unknown. Parathyroidectomy was performed within 1 y in 50% of patients. Within the 68% that met recommendations, parathyroidectomy was performed within 1 y in 54%; median time from diagnosis to surgery was shorter for males, patients aged ≤50 y, commercial/self-pay/no insurance patients (versus Medicaid/Medicare), and those with fewer comorbidities, P < 0.05. Multivariable analysis demonstrated non-Hispanic White patients and those with commercial/self-pay/uninsured were more likely to undergo parathyroidectomy after adjusting for comorbidity, age, and facility site. Among those strongly indicated, patients not on Medicare/Medicaid and aged ≤50 y were more likely to undergo parathyroidectomy after adjusting for race, comorbidity, and facility site. ConclusionsDisparities in parathyroidectomy for PHPT were observed. Insurance type was associated with undergoing parathyroidectomy; patients on governmental insurance were less likely to undergo surgery and waited longer for surgery despite strong indications. Barriers to referral and access to surgery should be investigated and addressed to optimize all patients’ access to care.

Robotic parathyroidectomy in primary hyperparathyroidism via the bilateral axillo-breast approach

Primary hyperparathyroidism is a common endocrine disorder that can be cured through surgical intervention. The majority of cases are caused by a single hyperfunctioning parathyroid adenoma. Focused parathyroidectomy is becoming more common as pre-operative localization techniques have improved. This approach minimizes the size of the incision while allowing safe dissection of the parathyroid glands in the confined space of the neck. Recent studies have reported that robotic parathyroidectomy (RP) was feasible with similar complication and success rates to open surgery. This case report describes the use of the robotic platform for focused parathyroidectomy via bilateral axillo-breast approach (BABA), demonstrating the feasibility and potential benefits of this approach.

AB043. SOH23ABS_051. Cardiovascular outcomes of parathyroidectomy in primary hyperparathyroidism: a systematic review and meta-analysis

Background: There is conflicting evidence on the benefits of parathyroidectomy (PTx) in reducing the incidence of cardiovascular disease (CVD) in patients with primary hyperparathyroidism (PHPT). The aim of this study was to perform a systematic review and meta-analysis to investigate the impact of PTx in PHPT on cardiovascular outcomes.

Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years - a prospective cohort study.

The impact of parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) on long-term quality of life (QoL) remains controversial. The study evaluated QoL changes 1 and 3 years after PTX. Patients undergoing PTX for PHPT between 2016 and 2022 ( n =329) were enrolled in this monocentric, prospective cohort study. QoL was evaluated using the SF-36 questionnaire before, 1 year, and 3 years after PTX and compared with an age-matched and sex-matched French reference population. Only patients with 1-year and 3-year follow-up and complete evaluation (serum calcium, phosphorus, parathyroid hormone) were included. A total of 159 patients were included (mean age: 62.6±12.7 years, 79.2% females). Mean serum calcium (2.66±0.20mmol/l) and median parathyroid hormone (96.4 [76.9-126.4]pg/ml) levels improved significantly after PTX. Before surgery, PHPT patients had impaired physical (44.6±8.9 vs. 47.6±6.8 in the reference population, P <0.001) and mental (42.3±10.9 vs. 48.9±6.8, P <0.001) component scores. The mean physical component score increased significantly at 1 and 3 years and was no longer different from the reference population (ratio: 0.94±0.15 preoperatively vs. 0.99±0.15 at 3 years, P <0.01). The mean mental component score increased significantly at 1 and 3 years, but remained significantly lower than the reference population. Before surgery, a lower physical component score and younger age were significantly associated with a 3-year physical component score increase on multiple linear regression analysis. A significant improvement in QoL is associated with PTX for PHPT at 1 year and is sustained for at least 3 years after surgery.

Does Surgeon Volume Impact Morbidity Following Parathyroidectomy? A Study of 16,140 Parathyroidectomies from the UK Registry of Endocrine and Thyroid Surgery (UKRETS) Database.

Outcomes in endocrine surgery have been shown to improve with surgeon volume. We aimed to study the effect of surgeon volume on morbidity following parathyroidectomy. UKRETS data from 2004 to 2019 was studied. Parathyroidectomies for primary hyperparathyroidism with complete data were included. Exclusion criteria were age <18 or >80years; surgeons contributing <10 cases overall; and length of stay >28days. Multivariable analysis was performed. Primary outcome was persistent hypercalcaemia; secondary outcomes were haemorrhage, length of stay, need for re-admission, post-operative hypocalcaemia, and need for calcium/vitamin D supplements to maintain eucalcaemia at 6months. 153 surgeons undertook mean 22.5 (median 17, range 2-115) parathyroidectomies/year. Persistent hypercalcaemia affected 4.8% (776/16140) overall; 5.7% (71/1242) in surgeons undertaking < 10cases/year; 5.1% (3339/6617) for 10-30cases/year; 5.0% (270/5397) for 30-50 cases; and 3.3% (96/2884) for >50 cases/year. High-volume (>50parathyroidectomies/year) surgeons operated 23.4% (809/3464) of negative localisation cases compared to 16.4% (2074/12676) of positive localisation cases. Persistent hypercalcaemia was almost twice as common in image negative (7.9%) compared to image-positive (4%) cases. Persistent hypercalcaemia was significantly more likely to occur in the low volume (<10parathyroidectomies/year) group than high volume (>50parathyroidectomies/year), regardless of image positivity (p = 0.0006). Surgeon volume significantly reduced persistent hypercalcaemia on multivariable analysis (OR = 0.878, 95%CI 0.842-0.914, p < 0.001), along with age, sex, and positive localisation. BNE and re-operation significantly increased persistent hypercalcaemia. Post-operative hypocalcaemia occurred in 3.2% (509/16040) and was reduced with increasing surgeon volume (OR = 0.951, 95%CI 0.910-0.993, p < 0.001). Haemorrhage and length of stay were not significantly associated with surgeon volume. The incidence of persistent hypercalcaemia, post-operative hypocalcaemia, and persistent hypoparathyroidism decreased with increasing surgeon volume. The relative reduction in persistent hypercalcaemia with surgeon volume was similar in image negative and positive groups, but the absolute reduction was higher in image negative cases. Restricting image negative parathyroidectomy to high-volume surgeons could be considered.