Modern advances in parathyroid surgery: A survey of North American surgeon associations.

BACKGROUND

Contemporary clinical guidelines recommend the use of intraoperative parathyroid hormone (IOPTH) when treating parathyroid disease, yet the degree to which parathyroid surgeons adhere to this, and other guideline recommendations remains unknown. To evaluate parathyroid surgeon practices when managing primary (PHPT), secondary (SHPT), and tertiary (THPT) hyperparathyroidism.

METHODS

A cross-sectional electronic survey characterizing parathyroid surgery practices was conducted according to CHEERS and AAPOR guidance and distributed to four North American surgeon societies from August-November 2024. The survey evaluated surgeon demographics, imaging practices, and surgical adjunct use. The primary outcome was the use of IOPTH. Descriptive and multivariable logistic regression analyses were used to explore parathyroid surgery practices and characteristics predictive of using IOPTH.

RESULTS

523 surgeons responded to this survey (response rate: 70.5%, range: 59.9%-85.7%). Most surgeons were from the US and Canada, while 56.3% of respondents were trained in otolaryngology-head and neck surgery. Ultrasonography was the most used modality, while IOPTH was most often used to guide parathyroid surgery [(376/426), 88.3%]. Intraoperative radioguidance and autofluorescence were used infrequently. IOPTH was used by US surgeons [adjusted odds ratio (aOR): 20.1; 95% CI: 1.9, 164.9; p < 0.01] who trained using IOPTH (aOR: 4.7; 95% CI: 1.2, 21.4; p < 0.05). Surveyed surgeons often used the Miami or modified Miami criteria when performing surgery for PHPT, while almost 30% of surgeons reported not using any IOPTH criteria during surgery for SHPT or THPT.

CONCLUSIONS

Surgeons adhere to clinical guidelines when managing parathyroid disease, especially with reference to IOPTH in minimally invasive parathyroidectomy. Practice heterogeneity, however, exists with reference to parathyroid imaging and the use of intraoperative adjuncts for parathyroid surgery in parathyroid disease, especially SHPT and THPT.