Non-adherence to consensus guidelines on preoperative imaging in surgery for primary hyperparathyroidism

Area of Science:

• Endocrinology
• Surgical Oncology
• Radiology

Background:

• Primary hyperparathyroidism (pHPT) management relies on accurate preoperative imaging.
• Consensus guidelines exist for optimal preoperative imaging in pHPT.
• Real-world adherence to these guidelines is not well-established.

Purpose of the Study:

• To assess adherence to preoperative imaging guidelines for pHPT in clinical practice.
• To evaluate the impact of guideline adherence on patient outcomes, specifically length of stay.
• To identify predictors of minimally invasive parathyroidectomy.

Main Methods:

• Retrospective multicenter cohort study.
• Analysis of 411 patients undergoing parathyroidectomy for pHPT (2007-2017).
• Evaluation of preoperative imaging workup (ultrasound, scintigraphy) against guidelines.

Main Results:

• 69% of patients (286/411) had preoperative imaging that adhered to guidelines.
• Guideline adherence was associated with a significantly shorter length of stay (63% vs. 37%, P < .0005).
• Bimodality imaging workup predicted minimally invasive parathyroidectomy (OR 4.098, P < .0005).

Conclusions:

• Compliance with preoperative imaging guidelines for pHPT is suboptimal.
• Adherence to guidelines improves patient outcomes, evidenced by shorter hospital stays.
• Enhanced physician education on appropriate pHPT imaging is necessary.