Role of hospital and patient factors on the outcome of reoperations for primary hyperparathyroidism: a retrospective multicenter cohort study

• Published in: International journal of surgery (London, England) Vol. 109; no. 11; pp. 3441 - 3449
• Main Authors: Nomine-Criqui, Claire, Nguyen-Thi, Phi-Linh, van Slycke, Sam, Makay, Ozer, Brunaud, Laurent, Bergenfelz, Anders
• Format: Journal Article
• Language: English
• Published: United States 01.11.2023
• Subjects: Clinical Medicine; Kirurgi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Surgery
• ISSN: 1743-9159; 1743-9159
• DOI: 10.1097/JS9.0000000000000613

There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism. We hypothesized that the variation in outcomes at the hospital level after reoperation would be significant. After accounting for this variability, some patient-level clinical criteria could be identified to help inform treatment decisions in this patient population. The aim of this study was to determine whether there is significant variation in outcomes after reoperation for primary hyperparathyroidism (PHPT) between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes. This retrospective multicenter cohort study was performed using the Eurocrine® registry. Data from 11 countries and 76 hospitals from January 2015 to October 2020 were extracted. A generalized linear mixed model was used to assess variation of outcomes at hospital level and to identify risk factors of postoperative outcomes at patient level. The primary endpoint (textbook outcome) was achieved when all six of the following postoperative conditions were met: no hypocalcemia or persistent hypercalcemia, no laryngeal nerve injury, no negative exploration, no normal parathyroid gland only on histopathology, and no postoperative death. Among 13593 patients who underwent parathyroidectomy for PHPT, 617 (4.5%) underwent reoperative parathyroidectomy. At follow-up, 231 patients (37.4%) were hypocalcemic, 346 (56.1%) were normocalcemic without treatment, and 40 (6.5%) had persistent hypercalcemia. Textbook outcomes were achieved in 321 (52.0%) patients. The hospital-level variation in textbook outcome rates was significant (P<0.001), and this variation could explain 29.1% of the observed outcomes. The criterion that remained significant after controlling for inter-hospital variation was "a single lesion on sestamibi scan or PET imaging" (odds ratio 2.08, 95% CI 1.24-3.48; P=0.005). Outcomes after reoperation are significantly associated with hospital-related factors. A "single lesion observed on preoperative sestamibi scan or positron emission tomography" appears relevant to select patients before reoperation.