Role of hospital and patient factors in the outcome of reoperations for primary hyperparathyroidism: a retrospective multicenter cohort study
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Tarih
2023
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
BACKGROUND: There are few data on outcomes after reintervention for persistent or recurrent primary hyperparathyroidism (PHPT). The authors 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 PHPT between hospitals (hospital-level analysis) and identify clinical factors (patient-level analysis) that influence postoperative outcomes. MATERIALS AND METHODS: 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 the variation in outcomes at the hospital level and to identify risk factors of postoperative outcomes at the 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. RESULTS: Among 13 593 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 positron emission tomography (PET) imaging' (odds ratio 2.08, 95% confidence interval 1.24-3.48; P =0.005). CONCLUSION: Outcomes after reoperation are significantly associated with hospital-related factors. A 'single lesion observed on preoperative sestamibi scan or PET' appears relevant to select patients before reoperation. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Açıklama
Anahtar Kelimeler
methoxy isobutyl isonitrile technetium tc 99m, parathyroid hormone, clinical trial, cohort analysis, complication, human, hypercalcemia, multicenter study, parathyroid gland, parathyroidectomy, pathology, primary hyperparathyroidism, procedures, reoperation, retrospective study, Cohort Studies, Humans, Hypercalcemia, Hyperparathyroidism, Primary, Parathyroid Glands, Parathyroid Hormone, Parathyroidectomy, Reoperation, Retrospective Studies, Technetium Tc 99m Sestamibi
Kaynak
International journal of surgery (London, England)
WoS Q Değeri
Scopus Q Değeri
Q1
Cilt
109
Sayı
11
