Gianluca Donatini1,2, Camille Marciniak3,4, Xavier Lenne5,6, Guillaume Clément5, Amélie Bruandet5,6, Frédéric Sebag7, Eric Mirallié8, Muriel Mathonnet9, Laurent Brunaud10, Jean-Christophe Lifante11, Christophe Tresallet12,13, Fabrice Ménégaux14, Didier Theis5, François Pattou3,4, Robert Caiazzo3,4. 1. Department of General and Endocrine Surgery, CHU Poitiers, Poitiers, France. 2. Inserm U1082 - IRTOMIT (Ischémie Reperfusion en Transplantation d'Organes Mécanismes et Innovations Thérapeutiques), Poitiers, France. 3. General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France. 4. Univ. Lille, Inserm, CHU Lille, U1190 - EGID, F-59000 Lille, France. 5. Medical Information Department, Lille University Hospital, Lille, France. 6. University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France. 7. APHM Hôpital La Conception, Department of Endocrine Surgery, Marseille, France. 8. CHU Nantes, Department of General and Endocrine Surgery, Nantes, France. 9. CHU Limoges, Department of General and Endocrine Surgery, Limoges, France. 10. Department of Gastrointestinal, Metabolic, and Surgical Oncology Multidisciplinary unit of obesity surgery (UMCO) Multidisciplinary unit of metabolic, endocrine and thyroid surgery (UMET) Université de Lorraine, CHRU NANCY, Hopital Brabois adultes INSERM U1256, Faculté de medicine 54511 Vandoeuvre les nancy, France. 11. CHU Lyon Sud, Department of General and Endocrine Surgery, Lyon, France. 12. APHP Pitié - Avicenne, Department of General and Endocrine Surgery, Paris, France. 13. Univ Sorbonne Paris Nord. 14. APHP Pitié - Salpitrière, Department of General and Endocrine Surgery, Paris, France.
Abstract
BACKGROUND: Surgical removal of hyperfunctional parathyroid gland is the definitive treatment for primary hyperparathyroidism (pHPT). Postoperative follow-up shows variability in persistent/recurrent disease rate throughout different centers. OBJECTIVE: To evaluate the incidence of redo surgery after targeted parathyroidectomy for pHPT. METHODS: We performed a nationwide retrospective cohort study on the "Programme de Medicalisation des Systemes d'Information," the French administrative database that collects information on all healthcare facilities' discharges. We extracted data from 2009 to 2018 for all patients who underwent parathyroidectomy for pHPT between January 2011 to December 2016. The primary outcome was the reoperation rate within 2 years since first surgery. Patients who had a first attempt of surgery within the previous 24 months, familial hyperparathyroidism, multiglandular disease, and renal failure were excluded. Results were adjusted according to sex and the Elixhauser Comorbidity Index. Operative volume thresholds to define high-volume centers were achieved by the Chi-Squared Automatic Interaction Detector method. RESULTS: In the study period, 13,247 patients (median age 63, F/M=3.6) had a focused parathyroidectomy by open (88.7%) or endoscopic approach. Need of remedial surgery was 2.8% at 2 years. In multivariate analysis, factors predicting redo surgery were: cardiac history (P=0.008), obesity (P=0.048), endoscopic approach (P=0.005), and low-volume center (P<0.001). We evaluated that an annual caseload of 31 parathyroidectomies was the best threshold to discriminate high-volume centers and carries the lowest morbidity/failure rate. CONCLUSION: Although focused parathyroidectomy represents a standardized operation, cure rate is strongly associated with annual hospital caseload, type of procedure (endoscopic), and patients' features (obesity, cardiac history). Patients with risk factors for redo surgery should be considered for an open surgery in a high-volume center.
BACKGROUND: Surgical removal of hyperfunctional parathyroid gland is the definitive treatment for primary hyperparathyroidism (pHPT). Postoperative follow-up shows variability in persistent/recurrent disease rate throughout different centers. OBJECTIVE: To evaluate the incidence of redo surgery after targeted parathyroidectomy for pHPT. METHODS: We performed a nationwide retrospective cohort study on the "Programme de Medicalisation des Systemes d'Information," the French administrative database that collects information on all healthcare facilities' discharges. We extracted data from 2009 to 2018 for all patients who underwent parathyroidectomy for pHPT between January 2011 to December 2016. The primary outcome was the reoperation rate within 2 years since first surgery. Patients who had a first attempt of surgery within the previous 24 months, familial hyperparathyroidism, multiglandular disease, and renal failure were excluded. Results were adjusted according to sex and the Elixhauser Comorbidity Index. Operative volume thresholds to define high-volume centers were achieved by the Chi-Squared Automatic Interaction Detector method. RESULTS: In the study period, 13,247 patients (median age 63, F/M=3.6) had a focused parathyroidectomy by open (88.7%) or endoscopic approach. Need of remedial surgery was 2.8% at 2 years. In multivariate analysis, factors predicting redo surgery were: cardiac history (P=0.008), obesity (P=0.048), endoscopic approach (P=0.005), and low-volume center (P<0.001). We evaluated that an annual caseload of 31 parathyroidectomies was the best threshold to discriminate high-volume centers and carries the lowest morbidity/failure rate. CONCLUSION: Although focused parathyroidectomy represents a standardized operation, cure rate is strongly associated with annual hospital caseload, type of procedure (endoscopic), and patients' features (obesity, cardiac history). Patients with risk factors for redo surgery should be considered for an open surgery in a high-volume center.