“Little is known about patient-level predictors of operative failure and persistent primary hyperparathyroidism (PHPT). Previous studies have attributed operative failure to inadequate preoperative imaging localization. Achievement of IOPTH criteria is a known predictor of operative success, though the final target IOPTH level is not agreed upon. Some researchers contend that final IOPTH levels should fall into the normal range, while others recommend lower levels. The independent contributions of preoperative localization, IOPTH biochemical cure, and preoperative biochemical severity to operative success are unclear. Better understanding of the relationship.”

“With this work, we show that multivariate techniques can be used to identify independent risk factors for operative failure after parathyroidectomy. We identified four independent predictors of persistent postoperative hypercalcemia: lower preoperative PTH, higher preoperative calcium, failure to meet IOPTH criteria, and smaller weight of excised glands. In addition to the well-established IOPTH criteria, we suggest that consideration of these
independent perioperative risk factors may further inform surgical decision-making in parathyroidectomy. Future studies can build upon these models to create robust yet practical metrics that can be used in clinics and operating rooms to assess risk of persistent disease.”

Cron, David C et al. “Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism.” American journal of surgery vol. 214,3 (2017): 509-514. Full Text for Emory Users