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Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients

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Abstract

Purpose

Preoperative localization procedures and the use of intraoperative parathyroidism (iOPTH) have led to a shift of paradigm from bilateral neck exploration to focused parathyroidectomy in primary hyperparathyroidism (pHPT). However, only a small number of randomized trials from specialized centers have been published. The main purpose of the study was to analyze the impact of localization procedures and iOPTH on short-term outcome after pHPT surgery in a multi-institutional setting.

Methods

An audit for quality assurance in pHPT surgery was performed in 23 Scandinavian departments in 2004–2008. Data were gathered prospectively in a database. Two thousand seven hundred and eight patients were registered and 78% were females. The median serum calcium level was 2.79 mmol/l.

Results

Localization procedures were performed in 1,831 patients (68%), (sestamibi in 54% and ultrasound in 41%) and iOPTH in 792 operations (29%). Bilateral exploration was performed in 61%, focused parathyroidectomy in 17%, and unilateral exploration in 22%. Histology showed parathyroid adenoma in 82%, with the median weight of 0.6 g. The alleviation of hypercalcemia at the first follow-up was 93% (94% for primary operation). In the multivariate logistic regression analysis, iOPTH increased cure rate (OR 1.70, 95% CI 1.14–2.53, p = 0.0092). The risk for postoperative medically treated hypocalcemia decreased with the use of localization procedures (OR 0.56, 95% CI 0.43–0.78, p = 0.0004) and iOPTH (OR 0.56, 95% CI 0.39–0.90, p = 0.0015).

Conclusions

Localization procedures and iOPTH decreased the risk for hypocalcemia after pHPT surgery. Additionally, iOPTH influenced short-term cure rate favorably.

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Acknowledgement

This study was supported by grants from:

The European Union (Interreg. IIIA)

The Swedish Board of Health and Social Welfare

The Swedish Association of Local Authorities and Regions

The following departments participated in this study:

Department of Surgery, Lund University Hospital

Department of Breast and Endocrine Surgery, Copenhagen University Hospital Rigshospitalet

Department of Surgery, Central Hospital, Kristianstad

Department of Surgery, Helsingborg Hospital

Department of Surgery, University Hospital of Uppsala

Center for Metabolism and Endocrinology, Karolinska University Hospital-Huddinge

Department of Surgery, Central Hospital, Halmstad

Department of Surgery, Falu Hospital

Department of Surgery, Växjö Central Hospital

Department of Surgery, Västerås Central Hospital

Department of Surgery, Södersjukhuset

Department of Surgery, Karolinska University Hospital

Department of Surgery, Sunderby Hospital

Department of Surgery and Transplantation, Sahlgrenska University Hospital

Department of Surgery, Nyköping Hospital

Department of Surgery, University Hospital of Umeå

Center for Endocrine Neck Surgery, ENT Department F, Odense University Hospital

Department of Surgery, Norra Älvsborgs Länssjukhus

Department of Surgery, Jönköping Hospital Ryhov

Department of Surgery, Åhus University Hospital

Department of Surgery, Karlstad Central Hospital

Department of Surgery, Sundsvall Hospital

Department of Surgery, Kungälv Hospital

Author information

Authors and Affiliations

  1. Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden

    Anders O. J. Bergenfelz

  2. Department of Surgery and Transplantation, Sahlgrenska University Hospital, Göteborg, Sweden

    Svante K. G. Jansson

  3. Department of Surgery, Örebro University Hospital, Örebro, Sweden

    Göran K. Wallin

  4. Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden

    Hans G. Mårtensson

  5. Center for Endocrine Neck Surgery, ENT Department F, Odense University Hospital, Odense, Denmark

    Lars Rasmussen

  6. Department of Surgery, Sunderby Hospital, Luleå, Sweden

    Håkan L. O. Eriksson

  7. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden

    Eva I. M. Reihnér

Authors
  1. Anders O. J. Bergenfelz
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  2. Svante K. G. Jansson
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  3. Göran K. Wallin
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  4. Hans G. Mårtensson
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  5. Lars Rasmussen
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  6. Håkan L. O. Eriksson
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  7. Eva I. M. Reihnér
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Corresponding author

Correspondence to Anders O. J. Bergenfelz.

Additional information

All authors are members of the Steering Committee of the Scandinavian Quality Register for Thyroid and Parathyroid Surgery

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Bergenfelz, A.O.J., Jansson, S.K.G., Wallin, G.K. et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg 394, 851–860 (2009). https://doi.org/10.1007/s00423-009-0540-6

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  • DOI: https://doi.org/10.1007/s00423-009-0540-6

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