Vladimir K Neychev1, Maher Ghanem2, Stuart L Blackwood3, Patricia Aragon Han2, Roghayeh Fazeli2, Eric Schneider2, Alireza Najafian2, Dov C Bloch3, Michael C Bard3, Jay H Klarsfeld3, Martha A Zeiger2, Richard J Lipton4. 1. Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA; Department of Surgery, "Alexandrovska" Hospital, Medical University of Sofia, 1 St. G. Sofiyski Blvd, Sofia 1431, Bulgaria. 2. Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine Blalock 606, 600 N Wolfe Street, Baltimore, MD 21287, USA. 3. Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA. 4. Danbury Hospital, 111 Osborne Street, Suite 122, Danbury, CT 06810, USA. Electronic address: richard.lipton@wchn.org.
Abstract
BACKGROUND: There is ongoing debate about the effectiveness and safety of performing parathyroid surgery in low-volume community hospitals. STUDY DESIGN/ METHODS: Cases performed at community hospital by a group of 4 parathyroid surgeons (group 1) were reviewed. Cure and complication rates were analyzed in light of outcomes of an expert endocrine surgeon from high-volume academic center (group 2) as point of reference. RESULTS: During the respective time periods, 204 patients met inclusion criteria in group1 and 218 patients in group 2. Patient characteristics, biochemical tests, and performed localizing studies (ultrasound and sestamibi scan) were comparable between the two groups. Pathological findings, including adenoma, double adenoma, hyperplasia, and cancer were comparable. Each had comparable cure rates (97% and 99%) (p < 0.18) and complication rates (1% and 1%) (p < 0.93) for group 1 and 2, respectively. CONCLUSION: Our results showed that experienced parathyroid surgeons will achieve comparable excellent outcomes of parathyroid surgery at both community and academic-based centers. As the field of endocrine surgery evolves and matures, producing young fellowship-trained endocrine surgeons, there will be growing need for expanding the niche of endocrine surgery into community-based hospital settings, which eventually will contribute to expanding and equalizing access to high-quality surgical care across urban and rural areas.
BACKGROUND: There is ongoing debate about the effectiveness and safety of performing parathyroid surgery in low-volume community hospitals. STUDY DESIGN/ METHODS: Cases performed at community hospital by a group of 4 parathyroid surgeons (group 1) were reviewed. Cure and complication rates were analyzed in light of outcomes of an expert endocrine surgeon from high-volume academic center (group 2) as point of reference. RESULTS: During the respective time periods, 204 patients met inclusion criteria in group1 and 218 patients in group 2. Patient characteristics, biochemical tests, and performed localizing studies (ultrasound and sestamibi scan) were comparable between the two groups. Pathological findings, including adenoma, double adenoma, hyperplasia, and cancer were comparable. Each had comparable cure rates (97% and 99%) (p < 0.18) and complication rates (1% and 1%) (p < 0.93) for group 1 and 2, respectively. CONCLUSION: Our results showed that experienced parathyroid surgeons will achieve comparable excellent outcomes of parathyroid surgery at both community and academic-based centers. As the field of endocrine surgery evolves and matures, producing young fellowship-trained endocrine surgeons, there will be growing need for expanding the niche of endocrine surgery into community-based hospital settings, which eventually will contribute to expanding and equalizing access to high-quality surgical care across urban and rural areas.