Protocol driven outcomes in renal parathyroid surgery

Abstract

Background Patients who require surgery for renal hyperparathyroidism represent a special population that is at high risk for postoperative complications. To optimize their treatment, we developed a multidisciplinary approach to the perioperative management of these patients undergoing parathyroidectomy. Methods The Augusta University endocrine surgery parathyroid database was interrogated to identify dialysis‐dependent patients undergoing parathyroidectomy from 2005 to 2015. Numerous clinical parameters were quantified. Patients were stratified into protocol patients and nonprotocol patients. Results A total of 42 patients undergoing renal parathyroidectomy who met the inclusion criteria were identified. Serious adverse events were nearly twice as common in the patients not treated on protocol. The length of stay was nearly 2 days shorter in the protocol group. Lowest calcium level and ionized calcium was higher in the protocol cohort despite a lower postoperative parathyroid hormone. The protocol group had fewer laboratory draws. Conclusion Implementation of a multidisciplinary renal hyperparathyroidism protocol has resulted in improved perioperative outcomes.

Osteocalcin is an Independent Predictor for Hungry Bone Syndrome After Parathyroidectomy

“…Certainly, risk factor identification can guide replacement therapy and streamline patient discharge. Studies have consistently shown that implementation of parathyroidectomy protocol can improve perioperative outcomes [26, 27]. Our current practice has reduced the hospital stay by 2 days compared to our previous report and maintained a low readmission rate.…”

Lessons Learned From a Single‐Surgeon Experience of More Than 1700 Parathyroidectomies

“…Renal patients are a special population with a completely different mechanism for their hyperparathyroidism, which requires a different pathophysiologic knowledge base, set of practice guidelines, 24 and surgical management protocols. 25 Nevertheless, the incidental surgical and anatomic education provided by exposure to these surgeries was enormously useful in refining intraoperative parathyroid identification strategies that apply directly and indirectly to patients with primary hyperparathyroidism.…”

“…Among patients who had failed prior surgery, typical errors in radiographic interpretation and surgical conduct were better understood (eg, the most frequent location for a missed adenoma, the overly descended superior gland, was identified 23 ; this knowledge facilitated successful primary surgical interventions in our own practice). Renal patients are a special population with a completely different mechanism for their hyperparathyroidism, which requires a different pathophysiologic knowledge base, set of practice guidelines, 24 and surgical management protocols 25 . Nevertheless, the incidental surgical and anatomic education provided by exposure to these surgeries was enormously useful in refining intraoperative parathyroid identification strategies that apply directly and indirectly to patients with primary hyperparathyroidism.…”