Clinical surgery-AmericanNegative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy
Section snippets
Methods
Permission was obtained from the Institutional Review Board of Columbia University to conduct a retrospective review of the Division of Gastrointestinal and Endocrine Surgery's Parathyroid Registry. Because of the retrospective nature of the study, the need for informed consent was waived. Data were exported from the Parathyroid Registry in a de-identified manner so that patient confidentiality was maintained.
The case records of 499 consecutive patients who underwent neck exploration for
Results
When comparing the negative and positive imaging groups, there were no differences in patient age (mean age, 58 y; range, 23–80 y vs 58 y; range, 12–92 y), sex (88% vs 78% women), preoperative mean calcium level (11.0 ± .8 mg/dL vs 11.3 ± .9 mg/dL), and PTH levels (129 ± 60 pg/mL vs 167 ± 63 pg/mL).
Neck exploration was performed under local anesthesia in 79.5% of positive imaging patients and 72.1% of negative imaging patients (P = not significant [NS]), with a similar rate of conversion to
Comments
In this study, we compared the outcomes of patients with positive preoperative localization with those with negative or discordant localization. This study and others have shown that PHPT patients with negative imaging often are more complex and difficult to treat.3, 19 In this subset of patients, there was a higher incidence of multigland disease and a higher rate of persistent hyperparathyroidism. Thus, in most cases, patients with unsuccessful localization before surgery require bilateral
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