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Updated: Aug 28, 2025

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Association of Implementation of Operating Room-Based Parathyroid Hormone Testing with Operative Time and Cost.

Steven Xie1, Jonathan Kuriakose1, Toni Beninato1,2

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Journal of the American College of Surgeons
|September 14, 2022
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Bringing intraoperative parathyroid hormone (IOPTH) testing to the operating room significantly reduces operative time and laboratory turnaround time. This advancement in IOPTH testing also leads to substantial cost savings in parathyroidectomy procedures.

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Area of Science:

  • Endocrinology
  • Surgical Pathology
  • Health Services Research

Background:

  • Intraoperative parathyroid hormone (IOPTH) testing is crucial for biochemical cure in parathyroidectomy but can be time-consuming.
  • Relocating a dedicated immunoassay machine to the operating room aimed to streamline IOPTH testing.

Purpose of the Study:

  • To determine the association of operating room-based IOPTH testing with operative time.
  • To evaluate the impact on laboratory turnaround time (TAT).
  • To assess the effect on the overall cost of care.

Main Methods:

  • Retrospective review of 285 patients undergoing parathyroidectomy (June 2017-February 2020).
  • Comparison of operative time and TAT before and after the acquisition of an in-room IOPTH machine.
  • Development of a cost model to analyze pre- and post-implementation expenses.

Main Results:

  • Median operative time decreased from 69 to 57 minutes (p=0.03) post-implementation.
  • Median TAT for IOPTH values at all measured time points (0-15 minutes) significantly decreased (p<0.001).
  • Total costs reduced from $4,442 to $4,111 per operation, with the machine paying for itself in 3 years.

Conclusions:

  • Operating room-based IOPTH testing enhances surgical productivity.
  • Reduced TAT and operative time are key benefits.
  • Implementation of in-room IOPTH testing leads to significant cost reduction and improved efficiency.