Faculty Collaboration Database

Outcomes and economic analysis of routine preoperative 4-dimensional CT for surgical intervention in de novo primary hyperparathyroidism: does clinical benefit justify the cost? J Am Coll Surg 2012 Apr;214(4):629-37; discussion 637-9

Date

02/11/2012

Pubmed ID

22321526

DOI

10.1016/j.jamcollsurg.2011.12.022

Scopus ID

2-s2.0-84862784586 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: Preoperative imaging in patients with primary hyperparathyroidism provides important localization information. Although 4-dimensional neck CT (4DCT) can precisely localize hyperfunctioning parathyroid tissue, the contribution of 4DCT to overall cost, operating room time, and hospital stay is unknown.

STUDY DESIGN: Records of 535 patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution from 1996 to 2010 were reviewed. All patients had preoperative cervical ultrasonography and sestamibi scanning, and most (78.9%) underwent preoperative 4DCT. A decision tree was constructed to compare extent of procedure, operating room time, length of stay, failure rate, and total cost of each strategy (with and without 4DCT). Costs were determined by 2010 Medicare reimbursement.

RESULTS: For patients with and without preoperative 4DCT, respectively, mean operating room time (64.4 vs 61.4 minutes; p = 0.58) and failure rate (1.9% vs 4.4%; p = 0.12) were not significantly different. Length of stay was higher in the no-CT cohort (0.61 vs 0.23 days; p < 0.001). Patients with a preoperative 4DCT were significantly more likely to undergo a limited parathyroidectomy (90.3% vs 80.5%; p = 0.004). Mean cost of care per patient in the CT and no-CT cohorts was $6,572 and $6,306, respectively.

CONCLUSIONS: The introduction of routine 4DCT into the preoperative workup for surgical intervention in primary hyperparathyroidism does not appear to shorten operating room time or decrease failure rate significantly. However, preoperative 4DCT is associated with shorter hospital stays and improved rates of minimally invasive parathyroidectomy. This clinical benefit must be weighed against the increased cost associated with routine preoperative 4DCT.

Author List

Abbott DE, Cantor SB, Grubbs EG, Santora R, Gomez HF, Evans DB, Lee JE, Vu T, Perrier ND

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cost-Benefit Analysis
Decision Trees
Four-Dimensional Computed Tomography
Hospital Costs
Humans
Hyperparathyroidism, Primary
Length of Stay
Middle Aged
Minimally Invasive Surgical Procedures
Models, Statistical
Parathyroidectomy
Preoperative Care
Texas
Time Factors
Treatment Failure
Treatment Outcome