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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 8/2019

01-12-2019 | Endocrine Surgery | Review Article

Parathyroid surgery: an evidence-based volume—outcomes analysis

European Society of Endocrine Surgeons (ESES) positional statement

Authors: Maurizio Iacobone, Gregorio Scerrino, F. Fausto Palazzo

Published in: Langenbeck's Archives of Surgery | Issue 8/2019

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Abstract

Background

The interest in correlation between hospital and surgeon practice volume and postoperative outcomes has grown considerably over the last decades; it has been suggested that surgery is likely to be associated with higher cure rates, lower morbidity and more favourable results in cost-effectiveness when performed in a high-volume setting. The aim of this paper is to undertake an evidence-based literature review of the relationship between surgical volume and clinical outcomes in parathyroidectomy for primary hyperparathyroidism. We used accepted quality markers to identify the relationship between volume and outcome with a view to defining a reproducible minimal surgical volume-related standard of care in parathyroid surgery.

Methods

A peer review literature analysis of volume and outcomes in parathyroid surgery was carried out and assessed from an evidence-based perspective. Results were discussed at the 2019 Conference of the European Society of Endocrine Surgeons devoted to “Volumes, Outcomes and Quality Standards in Endocrine Surgery”.

Results

Literature reports no prospective randomised studies; thus, a low level of evidence may be achieved.

Conclusions

Parathyroid surgery is at increased risk of failures, morbidity and need for reoperations and cost when performed in low-volume settings; thus, it should be concentrated in dedicated settings, with adequate annual volume and expertise. Acceptable results may be achieved moving parathyroid surgery cases away from low-volume settings (< 15 parathyroidectomies/year). Challenging procedures (primary hyperparathyroidism without unequivocal preoperative localization, hereditary variants, paediatric patients, reoperations) should be confined to high-volume settings (> 40 parathyroidectomies/year).
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Metadata
Title
Parathyroid surgery: an evidence-based volume—outcomes analysis
European Society of Endocrine Surgeons (ESES) positional statement
Authors
Maurizio Iacobone
Gregorio Scerrino
F. Fausto Palazzo
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 8/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-019-01823-9

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