Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism

David C Cron; Steven R Kapeles; Elizabeth A Andraska; Sebastian T Kwon; Peter S Kirk; Brendan L McNeish; Christopher S Lee; David T Hughes

doi:10.1016/j.amjsurg.2017.01.012

Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism

Am J Surg. 2017 Sep;214(3):509-514. doi: 10.1016/j.amjsurg.2017.01.012. Epub 2017 Jan 10.

Authors

David C Cron¹, Steven R Kapeles², Elizabeth A Andraska³, Sebastian T Kwon⁴, Peter S Kirk⁵, Brendan L McNeish⁶, Christopher S Lee⁷, David T Hughes⁸

Affiliations

¹ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: dcron@med.umich.edu.
² Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: skapeles@med.umich.edu.
³ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: eandras@med.umich.edu.
⁴ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: stkwon@med.umich.edu.
⁵ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: pkirk@med.umich.edu.
⁶ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: mcneishb@med.umich.edu.
⁷ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: cleeho@umich.edu.
⁸ Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: davhughe@med.umich.edu.

PMID: 28108069
DOI: 10.1016/j.amjsurg.2017.01.012

Abstract

Introduction: Many adjuncts guide surgical decision making in parathyroidectomy, yet their independent associations with outcome are poorly characterized. We examined a broad range of perioperative factors and used multivariate techniques to identify independent predictors of operative failure (persistent disease) after parathyroidectomy.

Methods: This was a retrospective review of 2239 patients with primary hyperparathyroidism who underwent parathyroidectomy at a single-center from 1999 to 2014. We used multivariate logistic regress to measure associations between multiple perioperative factors and an operative failure (persistent hypercalcemia).

Results: Operative failure was identified in 67 patients (3.0%). The following variables were independently associated with operative failure on multivariate analysis: IOPTH criteria met (protective, OR = 0.22, P < 0.001), preoperative calcium (risk factor, OR = 2.27 per unit increase, P < 0.001), weight of excised gland(s) (protective, OR = 0.70 per two-fold increase, P = 0.003), and preoperative PTH (protective, OR = 0.55 per two-fold increase, P = 0.008).

Conclusion: In addition to the well-established IOPTH criteria, we suggest that consideration of the above independent perioperative risk factors may further inform surgical decision-making in parathyroidectomy.

Keywords: Operative failure; Parathyroidectomy; Persistent hypercalcemia; Primary hyperparathyroidism.

MeSH terms

Female
Humans
Hyperparathyroidism, Primary / surgery*
Male
Middle Aged
Parathyroidectomy*
Prognosis
Retrospective Studies
Risk Factors
Treatment Failure