Variable practice patterns in the surgical management of renal hyperparathyroidism

Area of Science:

• Endocrinology
• Nephrology
• Surgical Oncology

Background:

• Hyperparathyroidism is prevalent in patients with chronic kidney disease, end-stage kidney disease, and post-kidney transplant.
• Clinical practice guidelines for surgical treatment of secondary and tertiary hyperparathyroidism have been published by the American Association for Endocrine Surgery.

Purpose of the Study:

• To assess current practice patterns for the surgical management of secondary and tertiary hyperparathyroidism.
• To evaluate surgical decision-making prior to the publication of new clinical guidelines.

Main Methods:

• A Qualtrics email survey was distributed to members of the American Association for Endocrine Surgery in 2022.
• Respondents were categorized by surgical subspecialty, annual parathyroidectomy volume, and specific volume for secondary/tertiary hyperparathyroidism surgery.
• Descriptive statistics and analysis of the role of surgical volume were performed.

Main Results:

• 142 responses (18% response rate) were received, with 84% identifying as endocrine surgeons.
• The majority of surgeons perform <10 parathyroidectomies annually for secondary and tertiary hyperparathyroidism (53.7%).
• Subtotal parathyroidectomy is the most common procedure, but consensus is lacking on preoperative management (calcitriol, cinacalcet) and postoperative care, including hypocalcemia protocols and intraoperative parathyroid hormone monitoring.

Conclusions:

• A significant portion of surgeons perform limited annual procedures for secondary and tertiary hyperparathyroidism.
• Subtotal parathyroidectomy is frequently used, yet considerable variation exists in perioperative management strategies.
• Dissemination of established guidelines presents an opportunity to standardize and improve the care of patients undergoing surgical treatment for hyperparathyroidism.