Endocrine Abstracts

Background: Concordant parathyroid localization studies using sestamibi and ultrasound scans allow minimally invasive parathyroidectomy to be the procedure of choice for patients with non-familial primary hyperparathyroidism (PHPT). This study investigates the financial implications of scan-directed parathyroid surgery.

Methods: Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre over a 5-year period.

Results: Between Jan 2003 and Oct 2007 a total of 200 patients (138F:62M, age 18–91 years) were operated for PHPT.

Minimal invasive parathyroidectomy was undertaken in 129 patients. Mean operative time was 39±18 min (range 10–95 min, median 20 min). Majority of patients were discharged same day (n=75, 59%) or within 23 h (n=44, 34%), with a total of 72 in-patient days (average 0.5 days/patient).

Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58±25 min (range 25–120 min, median 45 min). Nine patients were discharged same day and 47 (66%) within 23 h, with a total of 93 in-patient days (average 1.3 days/patient).

The estimated costs incurred are detailed (Table). These costs would have been covered by the recently introduced Payment by Results, which reimburses hospitals £2100 per parathyroidectomy (Dr Foster website).

Conclusion: Short operative time and day-case admission for minimally invasive parathyroidectomy can lead to costs savings that compensate for the additional costs associated with parathyroid imaging studies. Scan-directed parathyroidectomy is a financially sound management strategy and it should be the standard of care in centres with appropriate surgical experience.