Highlights
- •Concurrent parathyroid surgery with thyroidectomy carries an 8-fold increased risk of complications compared with parathyroidectomy alone.
- •Hypoparathyroidism, recurrent laryngeal nerve injury, and hematoma are significantly more likely following concurrent surgery.
- •Hypocalcemia is the largest driver of endocrine-related ED visits and hospital admissions in the post-op period.
- •These findings may help guide surgeon-patient discussions on the risks of concurrent parathyroid and thyroid surgery.
Abstract
Background
Studies comparing endocrine-specific outcomes following parathyroidectomy (PTx) versus
concurrent parathyroidectomy and thyroidectomy (PTx + Tx) are few.
Methods
10,019 patients were selected from the Collaborative Endocrine Surgery Quality Improvement
Program (2014–2019). Baseline characteristics and short-term (≤30 days) outcomes for
PTx + Tx vs PTx patients were compared using bivariate and multivariable methods.
Results
PTx + Tx patients were more likely to experience clinical hypoparathyroidism (6.7%
vs 0.5%, p < 0.001), recurrent laryngeal nerve transection, (0.4% vs 0.1%, p = 0.002)
and hematoma requiring evacuation (1.0% vs 0.2%, p < 0.001). Readmissions and ED visits
for hypocalcemia were more frequent after PTx + Tx vs PTx. Concurrent surgery was
associated with an 8-fold increase in risk of short-term complications (Odds Ratio
(OR): 8.0, 95% Confidence Interval (CI): 5.7–11.1, p < 0.001).
Conclusions
Patients undergoing PTx + Tx have increased rates of postoperative complications,
ED visits, and readmissions compared to patients undergoing parathyroidectomy alone.
These findings could help guide surgeon-patient discussions on the risks of concurrent
surgery.
Keywords
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References
- Epidemiology of primary hyperparathyroidism.J Clin Densitom. 2013; 16: 8-13
- The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism.JAMA Surgery. 2016; 151: 959-968
- Surgical approach to primary hyperparathyroidism in patients with concomitant thyroid diseases: a retrospective single center study.Internet J Endocrinol. 2020; (NA)
- Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism.Am J Otolaryngol. 2004; 25: 308-312
- Management of concomitant hyperparathyroidism and thyroid diseases in the elderly patients: a retrospective cohort study.Aging Clin Exp Res. 2017; 29: 29-33
- Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy.Surgery. 2008; 144: 862-867
- Co-existent thyroid disease in patients treated for primary hyperparathyroidism: implications for clinical management.Eur Arch Oto-Rhino-Laryngol. 2015; 272: 419-423
- Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism.Thyroid : off J Am Thyroid Assoc. 2007; 17: 59-62
- The devil is in the details: assessing treatment and outcomes of 6,795 patients undergoing remedial parathyroidectomy in the Collaborative Endocrine Surgery Quality Improvement Program.Surgery. 2019; 165: 242-249
- Does concomitant thyroidectomy increase risks of parathyroidectomy?.J Surg Res. 2016; 203: 34-39
- Morbidity associated with concomitant thyroid surgery in patients with primary hyperparathyroidism.Ann Surg Oncol. 2015; 22: 2707-2713
- Clinical and economic outcomes of thyroid and parathyroid surgery in children.J Clin Endocrinol Metabol. 2008; 93: 3058-3065
- Thyroid and parathyroid operations in veterans affairs and selected university medical Centers: results of the patient safety in surgery study.J Am Coll Surg. 2007; 204: 1222-1234
- Outcomes following thyroid and parathyroid surgery in pregnant women.Arch Surg. 2009; 144: 399-406
- Outcomes after thyroidectomy and parathyroidectomy.Head Neck. 2012; 34: 477-484
- Website for the collaborative endocrine surgery quality imrovement Program.(Available at:)
- Concomitant thyroid disease and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy.Gland Surg. 2017; 6: 368-374
- Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery.J Surg Res. 2012; 178: 264-267
- Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis.World J Surg. 2016; 40: 2359-2377
- Focused versus bilateral parathyroid exploration for primary hyperparathyroidism: a systematic review and meta-analysis.Ann Surg Oncol. 2017; 24: 1924-1934
- Surgical hypoparathyroidism.Endocrinol Metab Clin N Am. 2018; 47: 783-796https://doi.org/10.1016/j.ecl.2018.07.005
- Post-thyroidectomy emergency room visits and readmissions: assessment from the collaborative endocrine surgery quality improvement Program (CESQIP).Am J Surg. 2020; 220: 813-820
- Recurrent laryngeal nerve injury in thyroid surgery: a review.ANZ J Surg. 2013; 83: 15-21
- Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review.Int J Clin Pract. 2009; 63: 624-629
- Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve function during thyroidectomy.World J Surg. 2006; 30: 806-812
- Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk.Laryngoscope. 2002; 112: 124-133
- A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.Arch Surg. 2000; 135: 204-207
- The long-term impact of routine intraoperative nerve monitoring during thyroid and parathyroid surgery.Surgery. 2013; 154: 704-713
- Evacuation of postoperative hematomas after thyroid and parathyroid surgery: an analysis of the CESQIP Database.Surgery. 2019; 165: 250-256
- Racial disparities in voice outcomes after thyroid and parathyroid surgery.Surgery. 2013; 153: 103-110
- The impact of surgical volume on racial disparity in thyroid and parathyroid surgery.Ann Surg Oncol. 2014; 21: 2733-2739
- Racial disparities in clinical and economic outcomes from thyroidectomy.Ann Surg. 2007; 246: 1083-1091
- Race and gender disparities in access to parathyroidectomy: a need to change processes for diagnosis and referral to surgeons.Ann Surg Oncol. 2021; 28: 476-483
- Racial disparities in initial presentation of benign thyroid disease for resection.Ann Surg Oncol. 2016; 23: 2571-2576
Article Info
Publication History
Published online: March 25, 2022
Accepted:
March 23,
2022
Received in revised form:
February 26,
2022
Received:
December 19,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
