Predictors of operative failure in parathyroidectomy for primary hyperparathyroidism

“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.”

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Postoperative calcium requirements in 6,000 patients undergoing outpatient parathyroidectomy: easily avoiding symptomatic hypocalcemia.

Vasher M, Goodman A, Politz D, Norman J. Postoperative calcium requirements in 6,000 patients undergoing outpatient parathyroidectomy: easily avoiding symptomatic hypocalcemia. J Am Coll Surg. 2010 Jul;211(1):49-54. Full-text for Emory users.

Background: To determine the amount and duration of supplemental oral calcium for patients with varying clinical presentations discharged immediately after surgery for primary hyperparathyroidism.

Study design: A 4-year, prospective, single-institution study of 6,000 patients undergoing parathyroidectomy for primary hyperparathyroidism and discharged within 2.5 hours. Based on our previous studies, patients are started on a sliding scale of oral calcium determined by a number of preoperative measures (ie, serum calcium, body weight, osteoporosis) beginning 3 hours postoperation and decreasing to a maintenance dose by week 3. Patients reported all hypocalcemia symptoms daily for 2 weeks.

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