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For the Treatment of Primary Hyperparathyroidism Routine Four Gland Exploration Performed on an Outpatient Basis is as Successful and Safe as a Less Invasive Approach
*Marcoandrea Giorgi, *Seungjun Kim, Peter J Mazzaglia
Brown University, Providence, RI

Objective: To examine the safety and efficacy of four gland exploration in parathyroid surgery on an outpatient basis.
Design: Retrospective cohort.
Setting: Tertiary referral center.
Patients: All patients undergoing parathyroidectomy for primary hyperparathyroidism from January 2015 to March 2016 were included
Interventions: All patients underwent 4 gland exploration and parathyroidectomy by single surgeon on outpatient basis.
Main Outcome Measures: Operative success was based on intra-operative PTH levels, calcium and PTH measurements on post-op day 1 and at 2 weeks.
Results: There were 26 men and 90 women. Mean age was 58.5. Mean pre-op calcium was 11, pre-op PTH was 130. Pre-operative surgeon-performed ultrasound showed a single gland in 88.9%, double adenoma in 6%, multi-gland hyperplasia in 1.7% and was negative in 3.4% of cases. In surgery 67.3% had a single adenoma, 19.8% double adenoma, and 12.9% multi-gland hyperplasia. 64.6% were discharged home the same day. 41 patients were hospitalized because of: excision of ≥ 3 glands (16), re-exploration performed the same day when final PTH level didn't drop appropriately (3), need for concurrent total thyroidectomy (4), social factors (17). One patient required re-intubation and ICU admission for airway edema. There were no post-operative hematomas, wound infections, or recurrent laryngeal nerve injuries. Mean 24 hour post-op calcium was 9.4, the rate of transient hypocalcemia was 5%. One patient has persistent hypocalcemia. There were no readmissions. Mean 2 week post-op Ca was 9.4. Based on the two week follow-up calcium and PTH, operative success is 100%.
Conclusions: Routine four gland exploration remains a highly successful approach for the treatment of primary hyperparathyroidism. It can safely be performed on an outpatient basis when performed by an experienced surgeon.


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