Jesús Villar-Del-Moral1, João Capela-Costa2, Antonio Jiménez-García3, Antonio Sitges-Serra4, Daniel Casanova-Rituerto5, José Rocha6, Juan Manuel Martos-Martínez7, Aitor de la Quintana-Basarrate8, Jorge Rosa-Santos9, Xavier Guirao-Garriga10, José Miguel Bravo-de-Lifante11, Óscar Vidal-Pérez12, Antonio Moral-Duarte13, José Polónia14. 1. Endocrine Surgery Division, Department of Surgery, Virgen de las Nieves University Hospital, Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain. jesusm.villar.sspa@juntadeandalucia.es. 2. Endocrine Surgery Division, Department of Surgery, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. 3. Endocrine Surgery Division, Department of Surgery, Virgen Macarena University Hospital, Avenida Doctor Fedriani, 3, 41009, Sevilla, Spain. 4. Endocrine Surgery Division, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. 5. Endocrine Surgery Division, Department of Surgery, Marqués de Valdecilla University Hospital, Avenida Valdecilla, s/n, 39008, Santander, Spain. 6. Endocrine Surgery Division, Department of Surgery, Santa María University Hospital, Avenida Professor Egas Moniz, 1600-190, Lisbon, Portugal. 7. Endocrine Surgery Division, Department of Surgery, Virgen del Rocío University Hospital, Avenida Manuel Siurot, s/n, 41013, Sevilla, Spain. 8. Endocrine Surgery Division, Department of Surgery, Cruces University Hospital, Plaza de Cruces, 12, 48903, Barakaldo, Spain. 9. Head and Neck Surgery Service, Instituto Português de Oncologia (IPO) - Lisboa, R. Professor Lima Basto, 1099-023, Lisbon, Portugal. 10. Endocrine Surgery Division, Department of Surgery, Parc Taulí Hospital, Parc Taulí, 1, 08208, Sabadell, Spain. 11. Endocrine Surgery Division, Department of Surgery, Princesa University Hospital, Calle de Diego de León, 62, 28006, Madrid, Spain. 12. Endocrine Surgery Division, Department of Surgery, Clínic University Hospital, Carrer Villarroel, 170, 08036, Barcelona, Spain. 13. Endocrine Surgery Division, Department of Surgery, Santa Creu i Sant Pau University Hospital, Carrer de Sant Quintí, 89, 08026, Barcelona, Spain. 14. Hospital Santo Antonio, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
Abstract
PURPOSE: Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes. METHODS: An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions. RESULTS: Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038). CONCLUSIONS: Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.
PURPOSE: Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes. METHODS: An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions. RESULTS: Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038). CONCLUSIONS: Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.
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