Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy

BackgroundThis study compared reoperative complication rates after initial minimally invasive parathyroidectomy and standard cervical exploration.MethodsRecords from patients who underwent 1 reoperative parathyroidectomy at a single institution (1998 to 2012) were retrospectively reviewed.ResultsSeventy-seven patients were included; 74% underwent initial standard cervical exploration. Preoperative and operative characteristics were similar between groups; 74% underwent focused, unilateral reoperation. A significantly higher rate of postoperative complications occurred in the initial standard cervical exploration group (42% vs 15%, P = .03) that could not be explained by differences in the rates of symptomatic hypocalcemia (P = .5). The type of prior parathyroidectomy was significantly associated with postoperative complications (odds ratio 4.1, 95% confidence interval 1.1 to 15.7, P = .04). In a multivariable logistic regression model that included body mass index, type of operation (for initial and reoperation), and initial operation performed prereferral as covariates, type of prior parathyroidectomy remained a significant predictor of postoperative complications.ConclusionHigher rates of postoperative sequelae after initial standard cervical exploration should be considered before performing routine 4-gland exploration.