Is sestamibi-guided parathyroidectomy really cost-effective?

Background. Sestamibi-guided limited neck explorations are an alternative t o the standard bilateral neck exploration for patients with primary hyperpa rathyroidism. A recently published meta-analysis by Denham and Norman (JACS vol.186, 1998) suggested that a sestamibi-directed approach offers a cost benefit because it decreases operative and recovery room times, hospital st ay, and the number of frozen sections needed. Methods. We reviewed 41 bilateral neck explorations for primary hyperparath yroidism and compared our results with those reported by the meta-analysis to determine whether a sestamibi-directed approach Is cost effective. Results, Operative and recovery room times averaged 60.3 +/- 19.3 and 45 mi nutes, respectively. Forty six percent of the patients were treated as outp atients, and 1.21 +/- 0.57 frozen sections were obtained per case. Our stan dard bilateral exploration cost 47 % less than the bilateral approach and 1 7 % less than the sestamibi-directed operation calculated in the meta-analy sis. There were no cases of nerve injury or permanent hypocalcemia, 98 % of patients were cured, and 61 % of patients did not require narcotics postop eratively. Conclusions. Sestamibi-guided parathyroidectomy may not offer any advantage otter the standard bilateral exploration. In our experience, a bilateral n eck exploration can be performed on an outpatient basis and at low cost, wi th a high success rate and minimal morbidity. Most patients do not require narcotics, and the cosmetic results are excellent.