Volume-outcome relationship in parathyroid surgery

Best Pract Res Clin Endocrinol Metab. 2019 Oct;33(5):101287. doi: 10.1016/j.beem.2019.06.003. Epub 2019 Jun 15.

Abstract

Background: Since its first description, several studies have highlighted the role of the surgeon's experience in the outcome of parathyroid surgery, however, no uniform consensus exists regarding the minimum operative experience required for good surgical outcomes. This work aims to summarize the current data regarding the surgeon volume-outcome relationship for parathyroidectomy.

Methods: An electronic literature review identified 85 publications, and after study selection 11 were included. An additional nine publications were added based on reference review and inclusion of publications not initially captured.

Conclusions: There are insufficient data to dogmatically conclude a minimum number of cases required to achieve optimal surgical results. However, extrapolation from the inclusive studies support the conclusions that higher operative volumes improve cure rates and decrease the rates of complications, recurrent disease, and perioperative costs. Endocrine Surgery fellowships or mentorships may help prepare the less experienced surgeon for successful outcomes. Although reticent to offer firm minimal volume requirements, we have made suggestions in this manuscript.

Keywords: hyperparathyroidism; parathyroidectomy; surgeon experience; surgeon volume; surgeon volume–outcome relationship.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Humans
  • Parathyroid Neoplasms / surgery*
  • Parathyroidectomy / adverse effects
  • Parathyroidectomy / standards
  • Parathyroidectomy / statistics & numerical data*
  • Postoperative Complications / epidemiology*
  • Practice Guidelines as Topic
  • Procedures and Techniques Utilization / statistics & numerical data*