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The relationship between surgeon volume and outcomes of parathyroid surgery

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The parathyroid glands are 4 pea-sized glands located next to the thyroid gland in the neck. The parathyroid glands control the bodies calcium levels. Occasionally, one or more of the 4 parathyroid glands becomes overactive and calcium levels increase. This is called primary hyperparathyroidism and can lead to health problems such as thinning of the bones and kidney stones. The main treatment for hyperparathyroidism is surgery to remove the overactive gland, called a parathyroidectomy. In the United States, an estimated 17,000 parathyroidectomies are performed each year. Complications of a parathyroidectomy include low calcium levels and damage to the vocal cords.

Studies focused on non-parathyroid surgeries have consistently found an association between surgeon volume and patient outcome. For example, patients who undergo thyroid surgery are less likely to experience complications from the surgery if a surgeon performs the surgery frequently (high-volume surgeon) than if a surgeon only rarely performs the surgery (low-volume surgeon ). Less is known about whether such a relationship between surgeon volume and patient outcome exists for parathyroidectomies.

The goal of this study was to investigate the relationship between surgeon volume and patient outcome for parathyroid surgery in a population of patients who were admitted to a hospital for parathyroid surgery in England between April 2014 and March 2019.

Gray WK et al 2022 Volume-outcome associations for parathyroid surgery in England: Analysis of an administrative data set for the Getting It Right First Time program. JAMA Surg. 2022;157(7):581-588. PMID: 35507350.

The authors included data from 17,494 patients who underwent parathyroidectomies. Most of the patients studied were female (79.0%) and the average age was 62 (range 53-71) years. The surgeons were categorized based on how many parathyroid surgeries they performed in the previous 12 months: <10, 10-19, 20-29, 30-39, 40-49, and 50 or more. The author found that a higher surgeon volume was associated with lower rates of repeat parathyroid surgery within 1 year of the first parathyroid surgery. Patients who underwent parathyroid surgery with surgeons who performed less than 20 parathyroid surgeries a year (compared to at least 20 parathyroid surgeries per year) were 80% more likely to have vocal cord problem affecting voice, 63% more likely to have a repeat parathyroid surgery within 1 year, 59% more likely to stay in the hospital for more than 2 days following the initial parathyroid surgery, and 30% more likely to experience a complication from surgery.

This study provides evidence that patients have better outcomes after parathyroid surgery when they have the procedure performed by a higher volume surgeon. A minimum volume threshold of 20 parathyroid surgeries per year appears to be a reasonable target.

— Debbie Chen, MD


Hypoparathyroidism: low calcium levels due to decreased secretion of parathyroid hormone (PTH) from the parathyroid glands next to the thyroid. This can occur as a result of damage to the glands during thyroid surgery and usually resolves. This may also occur as a result of autoimmune destruction of the glands, in which case it is usually permanent.

Hypocalcemia: low calcium levels in the blood, a complication from thyroid surgery that is usually shortterm and relatively easily treated with calcium pills. If left untreated, low calcium may be associated with muscle twitching or cramping and, if severe, can cause seizures and/or heart problems.

Parathyroid glands: usually four small glands located around the thyroid that secrete parathyroid hormone (PTH) which regulates the body’s calcium levels.

Parathyroid hormone (PTH): the hormone that regulates the body’s calcium levels. High levels of PTH cause hypercalcemia, or too much calcium in the blood. Low levels of PTH cause hypocalcemia, or too little calcium in the blood.

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