SFEBES2023 Poster Presentations Bone and Calcium (41 abstracts)
A clinical audit on pre-operative work up and post-operative follow up in patients undergoing surgical management for primary hyperparathyroidism in a large tertiary Centre in the United Kingdom
Piyumi Wijewickrama , Helen Simpson , Stephanie Baldeweg , Umasuthan Srirangalingam , Tarek Abdel-Aziz , Tom Kurzawinski & Teng-Teng Chung
University College London Hospitals NHS Trust, London, United Kingdom
Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Aim of this audit was to assess clinical, biochemical parameters, localisation modalities and outcome in patients undergoing parathyroidectomy at University College London Hospital (UCLH).
Methods: We audited all patients aged 15-years or above, undergoing parathyroidectomy, from 01-02-2018 to 31-12-2021 at UCLH via retrospective data collection. The audit standards were as per the National-Institute-for-Health-and Care-Excellence (NICE) guidance, May 2019 and Journal-of Clinical-Endocrinology-and-Metabolism (JCEM) guideline 2018 (Table-1).
Results: There were 182 patients included. Majority 95 (52.2%) presented with incidental finding of asymptomatic hypercalcemia. Table-1 summarizes our performance against the audit standards.
| Section | Audit standard – 100% | Our performance n (%) |
| Diagnostic work-up | 25(OH) Vitamin D level | 166(91.2%) |
| Urine calcium excretion | 146(80.2%) | |
| Screening for end organ involvement | Dexa scan – lumbar spine, hip, distal 1/3 radius | Only 114 (62.6%) had a dexa scan Only 34 (18.6%) had distal radius assessment |
| Ultrasound kidneys | 97 (53%) | |
| Pre-operative localisation | Ultrasound neck | 181 (99.5%) |
| CT parathyroid | 166 (91.2%) | |
| Sestamibi | 91 (50%) | |
| IOPTH monitoring | Only in re-operation | 182 (100%) |
| Post-operative follow-up | Calcium before discharge | 175 (96%) |
| 3-6 months | 3 months data available in 176 (96.7%) |
Majority 100 (59.4%) had a hospital stay of 1-2 days, with 34 (18.7%) having a stay of <1 day. Three-month cure rate out of available data was 99.4% (175/176).Conclusion: This data confirmed pre-diagnostic work up, and post-operative follow up are up-to the audit standards. Combination of ultrasound and CT neck with IOPTH monitoring used at our centre lead to high cure rates. The areas to improve were, urine calcium assays, dexa scans including distal forearm and ultrasound kidneys for all aiding the surgery decision. We have already taken steps to improve through staff education, developing PHPT care pathways, and updating electronic order system to reflect specific dexa scan sites for PHPT.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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