Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy

BackgroundSuccessful preoperative localization plays an important role in patient selection for focused parathyroidectomy.MethodsThe case records of 499 consecutive patients with presumed hyperparathyroidism who underwent neck exploration were reviewed. Positive imaging patients (n = 373) had a localizing study that clearly showed a single abnormal parathyroid gland whereas negative imaging patients (n = 44) failed to localize or had discordant imaging results.ResultsPositive imaging patients were more likely to have a single adenoma (93.0% vs 72.1%; P < .001), and were less likely to require a bilateral exploration (8.1% vs 70.4%; P < .001). Negative imaging patients required more frozen sections (.9 ± 1.3 vs .2 ± .7; P < .001), and longer surgical time (77.3 ± 52.5 min vs 48.4 ± 34.6 min; P < .001). The cure rate was significantly higher in the positive imaging group (96.0% vs 87.1%; P < .03), with no difference in the incidence of complications (3.2% vs 2.3%; P value was not significant).ConclusionsPatients with unsuccessful or discordant preoperative localization have a higher incidence of multigland disease, lower cure rate, and consume more institutional resources than patients with successful preoperative localization.