AMBULATORY PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM

Objective: To evaluate whether the combined application of preoperativ e localization and intraoperative monitoring of intact parathyroid hor mone (iPTH) levels could facilitate safe outpatient parathyroidectomy. Design: Consecutive patients, who had no antecedent social or medical conditions mandating hospitalization, were prospectively offered ambu latory parathyroidectomy with a mean follow-up of 7 months (range, 1-2 5 months). Setting: Tertiary care referral center. Patients: From 85 p atients who had primary hyperparathyroidism with hypercalcemia and ele vated iPTH levels, 57 were offered outpatient parathyroidectomy. Ninet een patients were asymptomatic, 3 had hypercalcemic crisis, and the ot hers gave a history of renal stones or had complaints consistent with bone disease.Interventions: Technetium Tc 99m sestamibi scintiscans we re used for preoperative localization. Monitoring iPTH levels during p arathyroidectomy quantitatively assured the surgeon (G.L.I. only) when all hyperfunctioning glands were excised. Main Outcome Measure: The n umber of patients without complications and with short operative times who were discharged without hospital admission or overnight stay. Res ults: The combination of preoperative localization of abnormal parathy roid glands and a decline in circulating iPTH levels predicting postop erative normocalcemia after excision of all hyperfunctioning glands re sulted in successful parathyroidectomy in 84 of 85 patients. A decreas ed operative time (average, 52 minutes) with minimal neck dissection p ermitted outpatient parathyroidectomy in 42 of 57 eligible patients. C onclusions: The combination of preoperative parathyroid scintiscan loc alization and iPTH level monitoring during surgery permitted successfu l parathyroidectomy in an ambulatory setting in half of a consecutive series of patients with primary hyperparathyroidism. The safety, succe ss, and likely cost savings of this approach suggest wider application .