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Cost-effectiveness of scan-directed parathyroidectomy

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Abstract

Background

Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT).

Aim

To investigate the financial implications of scan-directed parathyroid surgery.

Methods

Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre.

Results

Two hundred patients (138F:62M, age 18–91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 ± 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 ± 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used (≈1.3days/patient). The estimated total costs incurred were £215,035 (≈290,000€). These costs would have been covered by the National Tariff (£2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations (£166,000 ≈ 224,100€).

Conclusion

Shorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.

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References

  1. Tibblin S, Bondeson A-G, Ljungberg O (1982) Unilateral parathyroidectomy in hyperparathyroidism due to single adenoma. Ann Surg 195:245–252 doi:10.1097/00000658-198203000-00001

    Article  PubMed  CAS  Google Scholar 

  2. Russell CF, Laird JD, Ferguson WR (1990) Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach? World J Surg 14(3):406–409 doi:10.1007/BF01658540

    Article  PubMed  CAS  Google Scholar 

  3. Haber RS, Kim CK, Inabnet WB (2002) Ultrasonography for preoperative localisation of enlarged parathyroid glands in primary hyperparathyoidism. Clin Endocrinol (Oxf) 57:241–249 doi:10.1046/j.1365-2265.2002.01583.x

    Article  Google Scholar 

  4. Sackett WR, Barraclough B, Reeve TS, Delbridge LW (2002) Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 137(9):1055–1059 doi:10.1001/archsurg.137.9.1055

    Article  PubMed  Google Scholar 

  5. Goldstein RE et al (2000) Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules. Ann Surg 231(5):732–742 doi:10.1097/00000658-200005000-00014

    Article  PubMed  CAS  Google Scholar 

  6. Gallagher SF, Denham DW, Murr MM, Norman JG (2003) The impact of minimally invasive parathyroidectomy on the way the endocrinologists treat primary hyperparathyroidism. Surgery 134(6):910–917 doi:10.1016/S0039-6060(03)00414-8

    Article  PubMed  Google Scholar 

  7. Genc H, Morita E, Perrier ND, Miura D, Ituarte P, Duh QY et al (2003) Different histological findings after bilateral and focused parathyroidectomy. J Am Coll Surg 196:535–540 doi:10.1016/S1072-7515(03)00108-X

    Article  PubMed  Google Scholar 

  8. Westerdahl J, Bergenfelz A (2004) Sestamibi scan-directed parathyroid surgery: potentially high failure rate without measurement of intraoperative parathyroid hormone. World J Surg 28:1132–1138 doi:10.1007/s00268-004-7484-3

    Article  PubMed  Google Scholar 

  9. Siperstein A, Berber E, Mackey R, Alghoul M, Wagner K, Milas M (2004) Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery 136(4):872–880 doi:10.1016/j.surg.2004.06.024

    Article  PubMed  Google Scholar 

  10. Agarwal G, Barraclough BH, Robinson BG, Reeve TS, Delbridge LW (2002) Minimally invasive parathyroidectomy using the ‘focused’ lateral approach. Results of the first 100 consecutive cases. ANZ J Surg 72(2):100–104 doi:10.1046/j.1445-2197.2002.02310.x

    Google Scholar 

  11. Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 232(3):331–339 doi:10.1097/00000658-200009000-00005

    Article  PubMed  CAS  Google Scholar 

  12. Gurnell EM, Thomas SK, McFarlane I, Munday I, Balan KK, Berman L et al (2004) Focused parathyroid surgery with intraoperative parathyroid hormone measurement as a day-case procedure. Br J Surg 91(1):78–82 doi:10.1002/bjs.4463

    Article  PubMed  CAS  Google Scholar 

  13. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J (2002) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomised controlled trial. Ann Surg 236(5):543–551 doi:10.1097/00000658-200211000-00001

    Article  PubMed  Google Scholar 

  14. Gauger PG, Agarwal G, England BG, Delbridge LW, Matz KA, Wilkinson M et al (2001) Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery 130(6):1005–1010 doi:10.1067/msy.2001.118385

    Article  PubMed  CAS  Google Scholar 

  15. Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG (2004) Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg 28:187–192 doi:10.1007/s00268-003-7255-6

    Article  PubMed  Google Scholar 

  16. Carneiro DM, Solorzano CC, Irvin GL 3rd (2004) Recurrent disease after limited parathyroidectomy for sporadic primary hyperparathyroidism. J Am Coll Surg 199(6):849–853 doi:10.1016/j.jamcollsurg.2004.08.013

    Article  PubMed  Google Scholar 

  17. Palazzo FF, Delbridge LW (2004) Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin North Am 84(3):717–734 doi:10.1016/j.suc.2004.01.002

    Article  PubMed  Google Scholar 

  18. British Association of Endocrine and Thyroid Surgeons (BAETS) guidelines. http://www.baes.info (accessed 6 April 2008)

  19. Mihai R, Palazzo F, Gleeson F, Sadler G (2006) Minimally invasive parathyroidectomy without intraoperative PTH monitoring in patients with primary hyperparathyroidism. Br J Surg 94(1):42–47 doi:10.1002/bjs.5574

    Article  Google Scholar 

  20. Scott-Combes D (on behalf of BAETS). BAETS second national audit report.

  21. Udelsman R (2004) Six hundred consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–672 doi:10.1097/00000658-200205000-00008

    Article  Google Scholar 

  22. Sejean K, Calmus S, Durand-Zaleski I et al (2005) Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysis. Eur J Endocrinol 153:915–927 doi:10.1530/eje.1.02029

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery—level 2, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK

    Radu Mihai, Mary Weisters, Michael J. Stechman & Greg Sadler

  2. Department of Radiology, Churchill Hospital, Oxford, UK

    Fergus Gleeson

Authors
  1. Radu Mihai
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  2. Mary Weisters
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  3. Michael J. Stechman
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  4. Fergus Gleeson
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  5. Greg Sadler
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Corresponding author

Correspondence to Radu Mihai.

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“Best of Endocrine Surgery in Europe 2008”

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Mihai, R., Weisters, M., Stechman, M.J. et al. Cost-effectiveness of scan-directed parathyroidectomy. Langenbecks Arch Surg 393, 739–743 (2008). https://doi.org/10.1007/s00423-008-0383-6

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  • DOI: https://doi.org/10.1007/s00423-008-0383-6

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