Prospective Audit and Review of Parathyroid Surgery in Rural Setting.
Faiz Tanweer1, Paul Zhaobo Liu2, Nilesh Vakharia2
1United Lincolnshire Hospitals NHS Trust, Lincoln, UK.
Summary
Endocrine multidisciplinary teams (MDT) improve outcomes for primary hyperparathyroidism (PHPT) surgery. This review of 53 parathyroidectomies showed a 92% reduction in post-operative PTH with minimal complications.
Area of Science:
- Endocrinology
- Surgical Outcomes
- Health Services Research
Background:
- Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder linked to substantial morbidity and mortality.
- The integration of endocrine multidisciplinary teams (MDT) has emerged as a critical factor in enhancing patient care and surgical outcomes for PHPT.
- Optimizing patient selection and perioperative management through MDT collaboration is key to reducing surgical complications.
Purpose of the Study:
- To evaluate the impact of an endocrine multidisciplinary team (MDT) on the outcomes of parathyroidectomy for primary hyperparathyroidism (PHPT).
- To assess the safety and efficacy of performing parathyroidectomies in a district general hospital setting.
- To analyze complication rates and patient outcomes following MDT-guided surgical intervention for PHPT.
Main Methods:
- A prospective review of 53 consecutive parathyroidectomies for PHPT performed between October 2016 and January 2020.
- Data collection included patient demographics, laboratory results, radiological findings, and operative outcomes.
- Surgical procedures were performed by a single surgeon, with patient selection and optimization guided by a dedicated endocrine MDT.
Main Results:
- A significant reduction in post-operative parathyroid hormone (PTH) levels was observed in 92% (46/53) of patients.
- No instances of vocal cord palsy, significant neck hemorrhage, or mortality were recorded.
- Low complication rates were reported, including temporary hypocalcemia in 6 patients and hungry bone syndrome in 2 patients.
Conclusions:
- Endocrine MDT involvement significantly influences positive outcomes and reduces complications in PHPT surgery.
- Parathyroidectomy can be safely and effectively performed in a district general hospital setting, even in rural locations.
- A collaborative team approach, including dedicated clinics and MDT meetings, is crucial for successful patient selection and optimization, leading to improved surgical results.
