THRESHOLDS FOR SURGERY AND SURGICAL OUTCOMES FOR PATIENTS WITH PRIMARY HYPERPARATHYROIDISM - A NATIONAL SURVEY OF ENDOCRINE SURGEONS

A 1991 NM. Consensus Development Conference statement provided recomme ndations for the management of patients with asymptomatic and minimall y symptomatic primary hyperparathyroidism (1 degrees HPT), but adheren ce to these guidelines has not been documented. We conducted a cross-s ectional survey of North American members of the American Association of Endocrine Surgeons inquiring about surgeon and 1 degrees HPT patien t characteristics, thresholds for surgery, and clinical outcomes. Mult ivariate regression was used to assess the relationship of physician c haracteristics to practice patterns and outcomes. Of 190 surgeons surv eyed, 147 (77%) responded; 109 provided complete responses (57%). Thes e surgeons spend 66% of their time in patient care and perform an aver age of 33 (range, 1-130) parathyroidectomies/yr. More than 72% of 1 de grees HPT patients who underwent surgery were asymptomatic or minimall y symptomatic. High volume surgeons (>50 cases/yr) had significantly l ower thresholds for surgery with respect to abnormalities in preoperat ive creatinine clearance, bone densitometry changes, and levels of int act PTH and urinary calcium compared to their low volume colleagues (1 -15 cases/yr). Overall reported surgical cure rates were 95.2% after p rimary operation and 82.7% after reoperation. Compared to high volume surgeons, low volume endocrine surgeons had significantly higher compl ication rates after primary operation (1.9% vs. 1.0% respectively; P < 0.01) and reoperation (3.8% vs. 1.5%; P < 0.001) as well as higher in -hospital mortality rates (1.0% vs. 0.04%; P < 0.05). Endocrine surgeo ns operate on a large number of asymptomatic or minimally symptomatic 1 degrees HPT patients. Even among a group of highly experienced surge ons who typically see patients after referral from endocrinologists, c linical outcomes and criteria for surgery vary widely and appear to be associated with surgeon experience. Their criteria for surgery diverg e from NIH guidelines. These results implore the endocrine community t o examine the evidential basis for decisions made in the management of 1 degrees HPT.