CONCISE PARATHYROIDECTOMY - THE IMPACT OF PREOPERATIVE SPECT TC-99M SESTAMIBI SCANNING AND INTRAOPERATIVE QUICK PARATHORMONE ASSAY

Background, Results of initial operation for sporadic primary hyperpar athyroidism are generally excellent, lent, yet today there is pressure to improve outcome and resource utilization. Methods. We designed a p rospective longitudinal cohort study comparing two approaches to conci se parathyroidectomy. Strategy A was defined as the palpation method f or selective unilateral exploration. Strategy B was defined as the rou tine use of both preoperative Tc-99m sestamibi single photon emission computed tomography (SPECT) imaging and intraoperative quick parathorm one assay. With either strategy the study period was 19 months and pat ients explored unilaterally were candidates for same-day discharge. We compared surgical outcome for 128 consecutive consenting patients eac h with 6 months or more of follow-up (mean 12 +/- 7.6 months). Results . Demographic, biochemical, and pathologic findings did not differ bet ween groups. SPECT imaging precisely localized hyperfunctioning parath yroid tissue. Compared with Strategy A (n = 61), the 67 patients treat ed by use of Strategy B experienced a higher rate of unilateral explor ation (41.0% versus 62.7%, p < 0.00001) and a shorter length of stay ( 1.07 versus 1.90 days, p < 0.00001) and trended to have shorter operat ive times, fewer operative failures, and less morbidity. Total periope rative costs did not differ between groups. Conclusions, Routine use o f intraoperative quick parathormone measurement and preoperative Tc-99 m sestamibi SPECT is as safe, effective, and cost-effective as convent ional approaches to parathyroidectomy. Use of this strategy is associa ted with significant reductions in extent of surgery and length of hos pital stay.