Ambulatory bilateral neck exploration for primary hyperparathyroidism: is it safe?

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Hyperparathyroidism management often involves surgical intervention.
• Ambulatory surgery is increasingly explored for parathyroidectomy to improve efficiency and patient convenience.

Purpose of the Study:

• To compare the safety and efficacy of bilateral neck exploration (BNE) versus focused parathyroidectomy for hyperparathyroidism in an ambulatory setting.
• To assess outcomes including same-day discharge, complication rates, and gland excision success.

Main Methods:

• Retrospective review of 503 patients undergoing parathyroidectomy between 2010 and 2015.
• Comparison of focused parathyroidectomy with BNE in patients with positive localization and no prior operations.
• Analysis of operative times, gland excision rates, same-day discharge, and adverse events.

Main Results:

• BNE was performed in 51% of patients, compared to 49% for focused parathyroidectomy.
• BNE was associated with a higher rate of excising one or more parathyroid glands (35% vs. 14%) and longer operative times (median 50 vs. 41 minutes).
• No significant differences were observed in same-day discharge rates, transient hypocalcemia, emergency department visits, or readmissions between the two approaches.

Conclusions:

• Bilateral neck exploration for hyperparathyroidism is a safe ambulatory procedure with comparable outcomes to focused parathyroidectomy.
• While BNE involves longer operative times and more gland excisions, it does not compromise patient safety or same-day discharge feasibility.
• These findings support the consideration of BNE in ambulatory settings for select hyperparathyroidism cases.