Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy

• Published in: The American journal of surgery 2014-11, Vol.208 (5), p.850-855
• Main Authors: Morris, Lilah F., M.D, Lee, Sukhyung, M.D, Warneke, Carla L., M.S, Abadin, Shabir S., M.D, Suliburk, James W., M.D, Romero Arenas, Minerva A., M.D., M.P.H, Lee, Jeffrey E., M.D, Grubbs, Elizabeth G., M.D, Perrier, Nancy D., M.D., F.A.C.S
• Format: Article
• Language: English
• Subjects: Dissection; Follow-Up Studies; Humans; Hyperparathyroidism, Primary - surgery; Logistic Models; Minimally invasive parathyroidectomy; Minimally Invasive Surgical Procedures; Parathyroidectomy - methods; Patients; Persistent or recurrent hyperparathyroidism; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Primary hyperparathyroidism; Reoperation - methods; Reoperative parathyroidectomy; Retrospective Studies; Standard cervical exploration; Studies; Surgery; Treatment Outcome; Tumors; Variables
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.05.006

Abstract Background This study compared reoperative complication rates after initial minimally invasive parathyroidectomy and standard cervical exploration. Methods Records from patients who underwent 1 reoperative parathyroidectomy at a single institution (1998 to 2012) were retrospectively reviewed. Results Seventy-seven patients were included; 74% underwent initial standard cervical exploration. Preoperative and operative characteristics were similar between groups; 74% underwent focused, unilateral reoperation. A significantly higher rate of postoperative complications occurred in the initial standard cervical exploration group (42% vs 15%, P = .03) that could not be explained by differences in the rates of symptomatic hypocalcemia ( P = .5). The type of prior parathyroidectomy was significantly associated with postoperative complications (odds ratio 4.1, 95% confidence interval 1.1 to 15.7, P = .04). In a multivariable logistic regression model that included body mass index, type of operation (for initial and reoperation), and initial operation performed prereferral as covariates, type of prior parathyroidectomy remained a significant predictor of postoperative complications. Conclusion Higher rates of postoperative sequelae after initial standard cervical exploration should be considered before performing routine 4-gland exploration.