Impact of body mass index on operative efficiency and outcomes in parathyroid surgery

The relationship between obesity and surgical outcomes is well described in major operations, but its influence on contemporary parathyroidectomy remains uncertain. This study evaluated the impact of raised body mass index (BMI) on operative efficiency, preoperative biochemistry, localization imaging, and perioperative outcomes in a single-surgeon cohort.

We retrospectively reviewed all parathyroidectomies performed by a single surgeon between September 2019 and September 2023. Patient demographics, BMI, operative duration, preoperative localization imaging, serum calcium and parathyroid hormone (PTH), length of stay, and complications were analyzed. Patients were classified as normal weight, overweight, or obese according to World Health Organization definitions. Continuous variables were compared using one-way ANOVA and categorical variables using chi-squared or Fisher's exact tests. Multivariate linear regression including age, sex, BMI category, operative extent and localization status identified independent predictors of operative time (p<0.05).

Among 225 patients (81.3% female; mean age 58 years), 39.6% were normal weight, 36.0% overweight, and 24.4% obese. Mean operative time was longer in obese patients (50.9 minutes) compared with normal weight (35.8 minutes) and overweight (35.5 minutes) groups (P < 0.001). Obese patients had higher preoperative PTH (P = 0.022), with no significant differences in serum calcium, localization imaging success, length of stay, cure rates, or complication rates.

Obesity was independently associated with prolonged operative time and higher preoperative PTH in patients undergoing parathyroidectomy, without an increase in complications or length of stay.