Evaluation of Surgical Practices and Outcomes in U.S. and European Cohorts of Patients with Primary Hyperparathyroidism

Background: The only definitive treatment for primary hyperparathyroidism (PHPT) is parathyroidectomy but there is great variability in the surgical approach and adjuncts testing used globaly. In this study, we performed a comparative analysis of the demographic, clinicopathologic features, and surgical approaches and outcomes between two centers with vastly different resources and healthcare systems: USA (Center A) and Latvia (Center B).
Method: Cross-sectional (2019-2022) analysis of PHPT patients and parathyroidectomy approach and outcome between two tertiary centers in 871 patients (Center A=644, Center B=227). Multivariable logistic regression analyses was used.
Results: Patients at Center A were older (median age 65 vs. 59 years, p<0.001) and had higher rate of multi-gland disease (32% vs. 17%, p<0.001). Although both sites most commonly used a focused parathyroidectomy approach, bilateral neck exploration was performed more often at Center A (35% vs. 23%, p<0.002). The use of intraoperative nerve monitoring was higher at Center A (94% vs. 5%, p<0.001). In contrast, intraoperative parathyroid hormone monitoring was employed in most cases at both centers (Center A:98%, Center B:100%) with >50% reduction in intraoperative PTH levels achieved in 96% of cases at both centers. Multi-gland disease was the strongest predictor of bilateral exploration (OR=5.16, p<0.001). Complication rates and length of hospital stay were not significantly different between the two centers.
Conclusions: Despite two distinct healthcare systems and resource settings with differences in PHPT demographic and parathyroid disease type, high biochemical cure rates and low complication rates can be achieved when the parathyroidectomies are done by endocrine surgeons.