Most surgeons reported using intraoperative parathyroid hormone monitoring, but approaches to imaging and intraoperative criteria varied, particularly in secondary and tertiary disease
To characterize contemporary management practices of primary, secondary, and tertiary hyperparathyroidism among North American surgeons, focusing on the use of intraoperative parathyroid hormone monitoring and imaging techniques.
Key Findings:
88% of surgeons reported using intraoperative parathyroid hormone monitoring (IOPTH) during parathyroid surgery.
Use of IOPTH was higher among US surgeons (98%) compared to Canadian (69%) and other regions (67%).
IOPTH was most frequently used in primary hyperparathyroidism (92%), followed by tertiary (77%) and secondary (76%) hyperparathyroidism.
64% of surgeons treating primary hyperparathyroidism used Miami or modified Miami criteria for decision-making.
Ultrasonography was the most common imaging modality reported across all hyperparathyroidism types, with specific percentages for each type.
Surgeons reported using IOPTH (44%) and frozen section analysis (39%) as the most common intraoperative adjuncts.
Interpretation:
Surgeons generally adhere to clinical guidelines for primary hyperparathyroidism, but there is less consensus in secondary and tertiary cases, indicating variability in practice that may impact patient outcomes.
Limitations:
Cross-sectional design may limit causal inferences.
Overrepresentation of US, academic, and English-speaking surgeons may affect generalizability, potentially skewing the results.
Conclusion:
While adherence to clinical recommendations is strong, significant practice heterogeneity exists in imaging and intraoperative technologies, particularly in renal hyperparathyroidism, highlighting the need for standardized guidelines.
Older age, male sex, underweight status, reduced activities of daily living, and mild consciousness disturbance were associated with postextubation pneumonia in elective surgical patients.
