Operative Failures After Parathyroidectomy For Hyperparathyroidism: The Influence Of Surgical Volume
Herbert Chen1, *Tracy Wang2, *Tina Yen2, *Kara Doffek2, *Elizabeth Krzywda2, *Sarah Schaefer1, *Rebecca S Sippel1, Stuart Wilson2
1University of Wisconsin, Madison, WI;2Medical College of Wisconsin, Milwaukee, WI
The surgical success rate for hyperparathyroidism from high volume centers exceeds 95%, but many patients have unsuccessful parathyroidectomies. While operative failure can be due to hyperfunctioning parathyroids in ectopic locations, less experienced surgeons may miss an abnormal parathyroid in normal anatomic locations, which we describe as “preventable operative failure”. We hypothesize that surgical volume influences the cause of operative failures.
We utilized two prospective databases containing over 2000 consecutive patients who underwent parathyroidectomy. We identified 159 patients with persistent/recurrent hyperparathyroidism subsequently cured with additional surgery. The initial failed operations were classified as being performed at high (>50 cases/year) or low volume (<50 cases/year) hospitals. Hospital volume was obtained from a state database of 89 hospitals which reported 6,336 parathyroid operations during the same decade.
Patients having their initial operation performed at the high or low volume centers were similar with regard to age, laboratory values, gender, and parathyroid weights. Despite a higher incidence of multi-gland disease (which increases the likelihood of operative failure) in the high volume group, patients in the low volume group were more likely to have a missed parathyroid gland in a normal anatomic location (89% vs. 13%, p<0.0001) and thus a higher proportion of preventable operative failures.
Surgical volume influences the failure pattern after parathyroidectomy for hyperparathyroidism. Preventable surgical failures are more common in low volume centers.
|HospitalParathyroid operations||Failed ops||Age||Pre-op Serum Calcium(mg/dl)||Pre-op PTH (pg/ml)||Missed gland weight (mg)||% Multiglandar hyperplasia||Preventable operative failures|