Cost-effectiveness of scan-directed parathyroidectomy.

Published on Aug 1, 2008in Langenbeck's Archives of Surgery2.184
· DOI :10.1007/S00423-008-0383-6
Radu Mihai27
Estimated H-index: 27
(John Radcliffe Hospital),
Mary Weisters2
Estimated H-index: 2
(John Radcliffe Hospital)
+ 2 AuthorsGreg Sadler8
Estimated H-index: 8
(John Radcliffe Hospital)
Sources
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).
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Background: Minimally invasive parathyroidectomy (MIP) is the preferred operation for patients with primary hyperparathyroidism (HPT) and positive preoperative imaging. This non-randomized case series assessed the long-term results of MIP performed without the use of intraoperative parathyroid hormone (ioPTH) monitoring. Methods: The study involved prospective collection of demographic, biochemical and operative details on a consecutive, unselected cohort of 298 patients who underwent surgery fo...
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Objectives: To examine the cost-effectiveness of strategies for management of primary asymptomatic hyperparathyroidism: surgical strategies and medical follow-up versus surgery. Design: We used a Markov state-transition decision-analytic model for an hypothetical cohort of 55year-old women to compare with a lifetime horizon costs and effectiveness of bilateral neck exploration (BNE), unilateral neck exploration (UNE), video-assisted parathyroidectomy (VAP) and lifelong medical follow-up shifting...
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#1Denise M. CarneiroH-Index: 15
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Background Limited parathyroidectomy guided by intraoperative parathyroid hormone (PTH) assay (QPTH) is highly successful (97% to 99%) in predicting postoperative eucalcemia, usually with less extensive dissection when compared with bilateral neck exploration. Because fewer glands are excised when resection is guided by QPTH as opposed to resection guided by gland size, a higher recurrence rate may occur. Recurrence rate after bilateral neck exploration is 0.4% to 5%, but frequency of recurrence...
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#1Johan Westerdahl (Lund University)H-Index: 27
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The present study evaluated sestamibi scan–directed parathyroidectomy with intraoperative parathyroid hormone (PTH) assessment (ioPTH). The preoperative sestamibi scintigraphies were compared with the intraoperative findings for 103 patients undergoing first exploration for sporadic primary hyperparathyroidism (pHPT). Data were collected prospectively. Ninety-nine patients (96%) were cured. Patients with persistent pHPT (n = 4) all had an incorrect scintigram as well as an insufficient decline o...
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Background The aim of this study was to determine the ability of localizing studies and rapid intraoperative parathyroid hormone (PTH) to predict the success of a limited approach in patients who then underwent bilateral exploration. Methods Preoperative sestamibi-iodine subtraction scan and neck ultrasonography (US) were used to direct a focal (1-gland) and unilateral (1-sided) parathyroid exploration by using rapid intraoperative PTH determinations in 350 patients with sporadic primary hyperpa...
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When minimally invasive parathyroidectomy (MIP) was last reviewed inSurgical Clinics of North America only 3 years ago, Howe [1] noted thata striking change had already taken place in the management of primaryhyperparathyroidism. The traditional paradigm of bilateral neck explora-tion (BNE) and four-gland evaluation was being replaced with one ofunilateral exploration and limited evaluation, based upon preoperativelocalization studies. In that review, a cogent case was made that unilateralexplor...
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Optimal interpretation of the results of intraoperative parathyroid hormone (IOPTH) monitoring during neck exploration for primary hyperparathyroidism (pHPT) is still controversial. The reliability of the “50% rule” in multiglandular disease (MGD) is often disputed, mostly because of competing pathophysiologic paradigms. The aim of this study was to ascertain and corroborate the ability of IOPTH monitoring to detect MGD in a practice, combining conventional and alternative parathyroid-ectomy tec...
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Background: This study assessed the feasibility, efficacy and safety of focused parathyroidectomy combined with intraoperative parathyroid hormone (IOPTH) measurement in a day-case setting. Methods: Over 28 months 50 consecutive patients (mean age 63 (range 33–92) years) with clear evidence of unifocal disease on sestamibi scanning or ultrasonography underwent unilateral neck exploration via a small lateral incision. Blood samples for measurement of IOPTH were taken at induction of anaesthesia, ...
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Abstract Background Minimally-invasive parathyroidectomy (MIP) appears to be changing preoperative treatment and referral patterns for sporadic, nonfamilial, non–multiple endocrine neoplasia, primary hyperparathyroidism (PHPT). Methods The American Association of Clinical Endocrinologists membership was surveyed by mail ( n = 1406 members) regarding physician practices and surgical referral patterns for PHPT. Results Seven hundred eighty-eight respondents (56%) practiced 17.0±0.4 years and refer...
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OBJECTIVE: To determine whether advanced imaging is cost-effective compared to primary bilateral neck exploration in the management of non-localizing primary hyperparathyroidism. STUDY DESIGN: Cost-effectiveness analysis. METHODS: Cost-effectiveness analysis based on decision tree model and available Medicare financial data using data from 347 consecutive patients having parathyroidectomy for primary hyperparathyroidism with either 1) positive, concordant ultrasound and sestamibi or 2) negative ...
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Abstract Background The cost-effectiveness of routine preoperative imaging for patients undergoing parathyroidectomy is controversial. The purpose of this study is to evaluate whether omission of routine preoperative imaging would affect efficiency or safety of parathyroidectomy. Methods We implemented a no-imaging protocol for patients with primary hyperparathyroidism and no prior neck surgery. If the patient did not have preoperative parathyroid imaging before evaluation by a surgeon, no radio...
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Primary hyperparathyroidism is a disease that is caused by excess parathyroid hormone (PTH) secretion from 1 or more of the parathyroid glands. Surgery is the only cure. Traditional surgical management consists of a 4-gland cervical exploration. Development of imaging specific to identification of parathyroid glands and application of the rapid PTH assay to operative management have made more minimal exploration possible. There are distinct advantages and disadvantages of minimally invasive para...
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Abstract Aim To determine the outcomes of bilateral neck exploration (BNE) and uptake as well as outcomes of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism in a district general hospital (DGH). Methods Patients who underwent first-time parathyroidectomy for primary hyperparathyroidism between August 1999 and December 2010 were identified from a prospectively maintained database of a single surgeon and were analysed for outcomes of MIP and BNE. MIP was adopted in 2006 ...
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Background Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative localization. This study examines the cost-utility of sestamibi in combination with single photon emission computed tomography (sestamibi-SPECT); ultrasound; and 4-dimensional computed tomography (4D-CT). Methods A decision tree was constructed for patients undergoing initial parathyroidectomy. Patients were randomized to 1 of 5 preoperative localization protocols: (1) ultrasound; (2)...
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Summary Objective Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly. Design and patients Consecutive patients with PHPT treated at a tertiary referral centre over 5 years. Measurements A prospective database recorded cl...
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