COST OF UNSUCCESSFUL SURGERY FOR PRIMARY HYPERPARATHYROIDISM

Background. Surgery for primary hyperparathyroidism demands skill and experience. The monetary and personal costs of unsuccessful surgery ar e investigated here. Method. We reviewed 47 consecutive patients opera ted on by one surgeon during a period of 16 months, including their cl inical data and medical costs of their treatment. Results. All 39 pati ents without previous operation were normocalcemic after operation, wi th no recurrent nerve injury mor hypoparathyroidism. Of the eight had undergone previous operation elsewhere, seven had abnormal glands that should have been resected at the initial operation, and hypoparathyro idism developed in two patients. Total costs or reoperative parathyroi d surgery were more than twice the cost of an initial operation (media n, $8383 versus $3948, p < 0.001) because of the cost of radiologic st udies (median, $3378 versus $43, p < 0.001). Conclusions. (1) An exper ienced parathyroid surgeon can consistently cure hyperparathyroidism a t the initial operation. (2) The majority of patients referred for hyp erparathyroidism not cured by previous operation have glands in usual anatomic locations. (3) The cost of the patient of an inadequate initi al operation includes the physical effects of remaining hyperparathyro id, additional time off work, potentially invasive localization testin g, reoperative surgery with increased risk of complications, and subst antial expense. Initial parathyroid surgery should be performed by sur geons experienced and proficient in its practice.