Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism?

Alex Dombrowsky, Deena Weiss, Norah Bushman, Herbert Chen, Courtney J. Balentine

Research output: Contribution to journalArticle

Abstract

Background: The cost-effectiveness of routine preoperative imaging for patients undergoing parathyroidectomy is controversial. The purpose of this study is to evaluate whether omission of routine preoperative imaging would affect efficiency or safety of parathyroidectomy. Methods: We implemented a no-imaging protocol for patients with primary hyperparathyroidism and no prior neck surgery. If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radiologic studies were ordered, and the patient was scheduled for parathyroidectomy. We used propensity matching to address differences between the imaging and no-imaging groups. Results: From 2000 to 2015, 83 patients underwent parathyroidectomy without imaging compared to 1245 patients with preoperative imaging. We successfully matched 64 patients with no preoperative imaging to equivalent patients who had imaging prior to surgery. Median age was 60 y, and 84% were women. There was no significant difference in operative time between patients with and without preoperative imaging (84 min for both groups, P < 0.32). Intraoperative parathyroid hormone levels dropped by at least 50% in all patients without preoperative imaging and in 98% of patients with imaging (P < 0.24). Neither group had recurrences 6 mo after surgery. Overall complication rates in the no-imaging (5%) and the imaging group (11%) were also similar (P < 0.18). Conclusions: Parathyroid surgery without preoperative imaging is safe, effective, and offers equivalent outcomes compared to an approach based on routine preoperative imaging. Experienced surgeons can consider omitting preoperative imaging in patients without a history of neck surgery as this may reduce overall treatment costs.

Original languageEnglish (US)
Pages (from-to)257-262
Number of pages6
JournalJournal of Surgical Research
Volume231
DOIs
StatePublished - Nov 2018
Externally publishedYes

Fingerprint

Primary Hyperparathyroidism
Parathyroidectomy
Neck
Operative Time
Parathyroid Hormone
Health Care Costs
Cost-Benefit Analysis

Keywords

  • Hyperparathyroidism
  • Imaging
  • Parathyroidectomy
  • Safety

ASJC Scopus subject areas

  • Surgery

Cite this

Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism? / Dombrowsky, Alex; Weiss, Deena; Bushman, Norah; Chen, Herbert; Balentine, Courtney J.

In: Journal of Surgical Research, Vol. 231, 11.2018, p. 257-262.

Research output: Contribution to journalArticle

Dombrowsky, Alex ; Weiss, Deena ; Bushman, Norah ; Chen, Herbert ; Balentine, Courtney J. / Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism?. In: Journal of Surgical Research. 2018 ; Vol. 231. pp. 257-262.
@article{843f5b903d4b44f6af88f775c3d54086,
title = "Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism?",
abstract = "Background: The cost-effectiveness of routine preoperative imaging for patients undergoing parathyroidectomy is controversial. The purpose of this study is to evaluate whether omission of routine preoperative imaging would affect efficiency or safety of parathyroidectomy. Methods: We implemented a no-imaging protocol for patients with primary hyperparathyroidism and no prior neck surgery. If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radiologic studies were ordered, and the patient was scheduled for parathyroidectomy. We used propensity matching to address differences between the imaging and no-imaging groups. Results: From 2000 to 2015, 83 patients underwent parathyroidectomy without imaging compared to 1245 patients with preoperative imaging. We successfully matched 64 patients with no preoperative imaging to equivalent patients who had imaging prior to surgery. Median age was 60 y, and 84{\%} were women. There was no significant difference in operative time between patients with and without preoperative imaging (84 min for both groups, P < 0.32). Intraoperative parathyroid hormone levels dropped by at least 50{\%} in all patients without preoperative imaging and in 98{\%} of patients with imaging (P < 0.24). Neither group had recurrences 6 mo after surgery. Overall complication rates in the no-imaging (5{\%}) and the imaging group (11{\%}) were also similar (P < 0.18). Conclusions: Parathyroid surgery without preoperative imaging is safe, effective, and offers equivalent outcomes compared to an approach based on routine preoperative imaging. Experienced surgeons can consider omitting preoperative imaging in patients without a history of neck surgery as this may reduce overall treatment costs.",
keywords = "Hyperparathyroidism, Imaging, Parathyroidectomy, Safety",
author = "Alex Dombrowsky and Deena Weiss and Norah Bushman and Herbert Chen and Balentine, {Courtney J.}",
year = "2018",
month = "11",
doi = "10.1016/j.jss.2018.05.046",
language = "English (US)",
volume = "231",
pages = "257--262",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Can imaging studies be omitted in patients with sporadic primary hyperparathyroidism?

AU - Dombrowsky, Alex

AU - Weiss, Deena

AU - Bushman, Norah

AU - Chen, Herbert

AU - Balentine, Courtney J.

PY - 2018/11

Y1 - 2018/11

N2 - Background: The cost-effectiveness of routine preoperative imaging for patients undergoing parathyroidectomy is controversial. The purpose of this study is to evaluate whether omission of routine preoperative imaging would affect efficiency or safety of parathyroidectomy. Methods: We implemented a no-imaging protocol for patients with primary hyperparathyroidism and no prior neck surgery. If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radiologic studies were ordered, and the patient was scheduled for parathyroidectomy. We used propensity matching to address differences between the imaging and no-imaging groups. Results: From 2000 to 2015, 83 patients underwent parathyroidectomy without imaging compared to 1245 patients with preoperative imaging. We successfully matched 64 patients with no preoperative imaging to equivalent patients who had imaging prior to surgery. Median age was 60 y, and 84% were women. There was no significant difference in operative time between patients with and without preoperative imaging (84 min for both groups, P < 0.32). Intraoperative parathyroid hormone levels dropped by at least 50% in all patients without preoperative imaging and in 98% of patients with imaging (P < 0.24). Neither group had recurrences 6 mo after surgery. Overall complication rates in the no-imaging (5%) and the imaging group (11%) were also similar (P < 0.18). Conclusions: Parathyroid surgery without preoperative imaging is safe, effective, and offers equivalent outcomes compared to an approach based on routine preoperative imaging. Experienced surgeons can consider omitting preoperative imaging in patients without a history of neck surgery as this may reduce overall treatment costs.

AB - Background: The cost-effectiveness of routine preoperative imaging for patients undergoing parathyroidectomy is controversial. The purpose of this study is to evaluate whether omission of routine preoperative imaging would affect efficiency or safety of parathyroidectomy. Methods: We implemented a no-imaging protocol for patients with primary hyperparathyroidism and no prior neck surgery. If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radiologic studies were ordered, and the patient was scheduled for parathyroidectomy. We used propensity matching to address differences between the imaging and no-imaging groups. Results: From 2000 to 2015, 83 patients underwent parathyroidectomy without imaging compared to 1245 patients with preoperative imaging. We successfully matched 64 patients with no preoperative imaging to equivalent patients who had imaging prior to surgery. Median age was 60 y, and 84% were women. There was no significant difference in operative time between patients with and without preoperative imaging (84 min for both groups, P < 0.32). Intraoperative parathyroid hormone levels dropped by at least 50% in all patients without preoperative imaging and in 98% of patients with imaging (P < 0.24). Neither group had recurrences 6 mo after surgery. Overall complication rates in the no-imaging (5%) and the imaging group (11%) were also similar (P < 0.18). Conclusions: Parathyroid surgery without preoperative imaging is safe, effective, and offers equivalent outcomes compared to an approach based on routine preoperative imaging. Experienced surgeons can consider omitting preoperative imaging in patients without a history of neck surgery as this may reduce overall treatment costs.

KW - Hyperparathyroidism

KW - Imaging

KW - Parathyroidectomy

KW - Safety

UR - http://www.scopus.com/inward/record.url?scp=85048896588&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048896588&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2018.05.046

DO - 10.1016/j.jss.2018.05.046

M3 - Article

C2 - 30278938

AN - SCOPUS:85048896588

VL - 231

SP - 257

EP - 262

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -