Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
1.
Surgery ; 171(1): 55-62, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34340823

RESUMEN

BACKGROUND: Primary hyperparathyroidism historically necessitated bilateral neck exploration to remove abnormal parathyroid tissue. Improved localization allows for focused parathyroidectomy with lower complication risks. Recently, positron emission tomography using radiolabeled 18F-fluorocholine demonstrated high accuracy in detecting these lesions, but its cost-effectiveness has not been studied in the United States. METHODS: A decision tree modeled patients who underwent parathyroidectomy for primary hyperparathyroidism using single preoperative localization modalities: (1) positron emission tomography using radiolabeled 18F-fluorocholine, (2) 4-dimensional computed tomography, (3) ultrasound, and (4) sestamibi single photon emission computed tomography (SPECT). All patients underwent either focused parathyroidectomy versus bilateral neck exploration, with associated cost ($) and clinical outcomes measured in quality-adjusted life-years gained. Model parameters were informed by literature review and Medicare costs. Incremental cost-utility ratios were calculated in US dollars/quality-adjusted life-years gained, with a willingness-to-pay threshold set at $100,000/quality-adjusted life-year. One-way, 2-way, and threshold sensitivity analyses were performed. RESULTS: Positron emission tomography using radiolabeled 18F-fluorocholine gained the most quality-adjusted life-years (23.9) and was the costliest ($2,096), with a total treatment cost of $11,245 or $470/quality-adjusted life-year gained. Sestamibi single photon emission computed tomography and ultrasound were dominated strategies. Compared with 4-dimentional computed tomography, the incremental cost-utility ratio for positron emission tomography using radiolabeled 18F-fluorocholine was $91,066/quality-adjusted life-year gained in our base case analysis, which was below the willingness-to-pay threshold. In 1-way sensitivity analysis, the incremental cost-utility ratio was sensitive to test accuracy, positron emission tomography using radiolabeled 18F-fluorocholine price, postoperative complication probabilities, proportion of bilateral neck exploration patients needing overnight hospitalization, and life expectancy. CONCLUSION: Our model elucidates scenarios in which positron emission tomography using radiolabeled 18F-fluorocholine can potentially be a cost-effective imaging option for primary hyperparathyroidism in the United States. Further investigation is needed to determine the maximal cost-effectiveness for positron emission tomography using radiolabeled 18F-fluorocholine in selected populations.


Asunto(s)
Análisis Costo-Beneficio/estadística & datos numéricos , Hiperparatiroidismo Primario/diagnóstico , Glándulas Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico , Tomografía de Emisión de Positrones/economía , Colina/administración & dosificación , Colina/análogos & derivados , Colina/economía , Radioisótopos de Flúor/administración & dosificación , Radioisótopos de Flúor/economía , Tomografía Computarizada Cuatridimensional/economía , Humanos , Hiperparatiroidismo Primario/economía , Hiperparatiroidismo Primario/etiología , Hiperparatiroidismo Primario/cirugía , Medicare/economía , Medicare/estadística & datos numéricos , Modelos Económicos , Glándulas Paratiroides/patología , Glándulas Paratiroides/cirugía , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Tomografía Computarizada por Tomografía de Emisión de Positrones/economía , Tomografía de Emisión de Positrones/métodos , Cuidados Preoperatorios/economía , Cuidados Preoperatorios/métodos , Años de Vida Ajustados por Calidad de Vida , Radiofármacos/administración & dosificación , Radiofármacos/economía , Sensibilidad y Especificidad , Tecnecio Tc 99m Sestamibi/administración & dosificación , Tecnecio Tc 99m Sestamibi/economía , Ultrasonografía/economía , Estados Unidos
2.
Am J Otolaryngol ; 42(3): 102907, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33460975

RESUMEN

PURPOSE: To present the results of our implementation of a four-dimensional computed tomography- (4DCT) based parathyroid localization protocol for primary hyperparathyroidism at a safety net hospital. METHODS: We performed a retrospective review of all patients who underwent parathyroidectomy for primary hyperparathyroidism at Elmhurst Hospital Center from June 2016 - September 2019. Patients treated prior to the implementation of 4DCT during October 2018 served as historical controls for comparison. Imaging-related costs and hospital charges were obtained from the Radiology Department for each patient. RESULTS: Forty-two patients underwent parathyroid surgery during the study period. Twenty patients had undergone 4DCT while 22 had nuclear medicine studies with or without ultrasonography. The sensitivity and specificity of 4DCT was 90.4% and 100% respectively, compared to 63% and 93.7% for nuclear imaging studies and 41% and 95% for ultrasound. The mean number of glands explored was significantly less in the 4DCT group, 1.8 ± 1.19 versus 2.77 ± 1.26 (p = 0.01). There was no increase in infrastructure or personnel costs associated with 4DCT implementation. CONCLUSIONS: 4DCT represents an increasingly common imaging modality for pre-operative parathyroid localization. Here we demonstrate that 4DCT is associated with a reduction in the number of glands explored and enables minimally invasive parathyroid surgery. 4DCT is a cost-effective and clinically sound localization study for parathyroid localization in an urban safety-net hospital.


Asunto(s)
Adenoma/diagnóstico por imagen , Tomografía Computarizada Cuatridimensional/métodos , Glándulas Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Adenoma/economía , Adenoma/cirugía , Adulto , Anciano , Análisis Costo-Beneficio , Femenino , Tomografía Computarizada Cuatridimensional/economía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/educación , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Glándulas Paratiroides/cirugía , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/economía , Paratiroidectomía/métodos , Periodo Preoperatorio , Adulto Joven
3.
JAMA Surg ; 148(6): 500-3, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23575888

RESUMEN

IMPORTANCE: Dynamic computed tomography (CT) is emerging as a first-line alternative to sestamibi scintigraphy for preoperative localization of parathyroid lesions. In recent years, there has been increased concern over the impact of radiation exposure from medical imaging, as well as on the cost of diagnostic medical procedures. An ideal diagnostic procedure would be cost effective while minimizing hazardous exposures and complication rates. OBJECTIVE: To compare the radiation dose and financial cost of dynamic CT with sestamibi scintigraphy. DESIGN, SETTING, AND PATIENTS: A retrospective review of 263 patients at a large, urban, tertiary referral center who underwent either dynamic parathyroid CT or sestamibi scintigraphy for any etiology of hyperparathyroidism from 2006 through 2010. MAIN OUTCOMES AND MEASURES: The 2 primary study outcomes were radiation exposure measured in millisieverts (mSv) and medical charges for the respective diagnostic procedures. The study was conducted with the hypothesis that dynamic parathyroid CT would have slightly greater radiation exposure with similar cost to sestamibi scintigraphy. RESULTS: Dynamic parathyroid CT and sestamibi scintigraphy delivered mean radiation doses of 5.56 and 3.33 mSv, respectively (P < .05). Charges totaled $1296 for thin-cut dynamic parathyroid CT and a mean of $1112 for sestamibi scintigraphy, depending on the type and amount of radiotracer injected. Although multiphase CT scanning took less than 5 minutes, sestamibi scintigraphy lasted a mean time of 306 minutes. A total of 62 of 119 patients (52%) in the CT group have undergone operative treatment to date, whereas all patients in the sestamibi arm underwent operative treatment of their hyperparathyroidism. Of the patients who underwent a surgical procedure, CT correctly identified the side of the parathyroid adenoma in 54 of 62 patients (87%), while sestamibi scintigraphy only correctly lateralized 90 of 122 adenomas (74%) as confirmed by exploratory surgery, intraoperative parathyroid hormone levels, and pathologic features. A dynamic parathyroid CT correctly predicted multiglandular disease in 1 of 7 patients (14%), while sestamibi scintigraphy correctly predicted multiglandular disease in 8 of 23 patients (35%). CONCLUSIONS AND RELEVANCE: In patients who underwent directed parathyroid surgery, dynamic CT is comparable to sestamibi scintigraphy in patients with hyperparathyroidism. Although CT delivers a higher dose of radiation, the average background radiation exposure in the United States is 3 mSv/y, and added exposures of less than 15 mSv are considered low risk for carcinogenesis. Overall, dynamic parathyroid CT is a safe, cost-effective alternative to sestamibi scintigraphy.


Asunto(s)
Adenoma/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada por Rayos X/economía , Adenoma/economía , Costo de Enfermedad , Análisis Costo-Beneficio , Femenino , Humanos , Hiperparatiroidismo/cirugía , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/cirugía , Neoplasias de las Paratiroides/economía , Cuidados Preoperatorios , Dosis de Radiación , Cintigrafía , Radiofármacos/economía , Estudios Retrospectivos , Tecnecio Tc 99m Sestamibi/economía , Tomografía Computarizada por Rayos X/métodos
4.
Otolaryngol Head Neck Surg ; 147(3): 438-43, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22535912

RESUMEN

OBJECTIVE: To determine demographics and cost for outpatients undergoing parathyroid surgery at hospitals belonging to the University Health System Consortium (UHC). STUDY DESIGN: UHC data were accessed in 2011 and reflected data collected from 2005 through 2010 (24 quarters). Searching strategy was based on diagnoses of parathyroid disease and patients undergoing parathyroidectomy across all UHC member facilities. Complications evaluated in this analysis included: hypocalcemia, hypoparathyroidism, aspiration pneumonia, hematoma, wound infection, stroke, myocardial infarction, deep venous thrombosis/pulmonary embolism (PE), and death. SETTING: The University Health System Consortium, Oak Brook, Illinois, was formed in 1984 and consists of 112 academic medical centers and 250 of their affiliated hospitals. This represents 90% of the nonprofit academic medical centers in the United States (www.uhc.edu). SUBJECTS AND METHODS: Patients enrolled in the UHC database were studied retrospectively. Data were compiled from discharge summaries into a secure, interactive, Web-based database. The outpatient data collection set has been a recent addition to the originally established UHC inpatient discharge database. RESULTS: There were 21,057 patients who had outpatient parathyroid surgery. The average age was 59.0 (0.8-96.2) yrs. Seventy-six percent of patients were female. Outpatient parathyroidectomy had lower charges than inpatient surgery ($12,738 and $14,657, respectively; P = 0.004, Wilcoxon signed-rank test). Complications were low but were likely underreported. CONCLUSION: Parathyroid surgery is increasingly being done in the outpatient setting in the United States. By virtue of omitting inpatient hospitalization, the outpatient approach becomes a more economical way to manage parathyroid disease. This is the largest known series reporting experience with outpatient parathyroid surgery.


Asunto(s)
Centros Médicos Académicos , Adenoma/cirugía , Procedimientos Quirúrgicos Ambulatorios , Enfermedades de las Paratiroides/cirugía , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/métodos , Complicaciones Posoperatorias/etiología , Centros Médicos Académicos/economía , Adenoma/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/economía , Niño , Preescolar , Ahorro de Costo , Femenino , Precios de Hospital , Humanos , Illinois , Lactante , Masculino , Persona de Mediana Edad , Enfermedades de las Paratiroides/economía , Neoplasias de las Paratiroides/economía , Paratiroidectomía/economía , Complicaciones Posoperatorias/economía , Adulto Joven
5.
Ann Surg Oncol ; 18(9): 2555-63, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21409487

RESUMEN

BACKGROUND: (99m)Technetium-sestamibi hybrid SPECT/CT has been favored over conventional SPECT in preoperative evaluation of primary hyperparathyroidism (PHPT) patients. However, the financial implications of CT-image acquisition have never before been published. This prompted us to perform a cost analysis of the aforementioned nuclear procedures. METHODS: A total of 55 PHPT patients operated on between 2004 and 2009 were studied. Overall, 27 patients underwent SPECT and 28 SPECT/CT. Localization results, as well as diagnostic and clinical cost variations between SPECT and SPECT/CT patients, were compared. RESULTS: SPECT/CT revealed higher sensitivity than SPECT (96.7 vs 79.3%; P = .011), as well as higher specificity (96.4 vs 82.4%; P = .037) and positive predictive value (PPV) (96.7 vs 83%; P = .038) for correctly identifying the neck-side affected by PHPT. Likewise, SPECT/CT disclosed higher sensitivity (86.7 vs 61.1%; P < .0001), specificity (97.4 vs 90%; P = .022), and PPV (86.7 vs 65.7%; P = .0001) for correct neck-quadrant identification. The mean operative time decreased from 62 min following SPECT to 36 min following SPECT/CT (P < .0001), yielding a mean surgical expense saving of 109.9 /patient (updated at 2009/2010 billing database). SPECT/CT actually ensures a mean expenditure reduction of 98.7 /patient (95% CI: 47.96 -149.42 ), diagnostic costs variation amounting to 11.2 /procedure. CONCLUSIONS: SPECT/CT ensures better focus for the surgical exploration, shortens surgical times, and eventually cuts costs when used for localization of parathyroid adenomas.


Asunto(s)
Adenoma/economía , Hiperparatiroidismo/economía , Neoplasias de las Paratiroides/economía , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Adenoma/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Hiperparatiroidismo/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico por imagen , Pronóstico , Radiofármacos , Sensibilidad y Especificidad , Tasa de Supervivencia , Adulto Joven
7.
Langenbecks Arch Surg ; 393(5): 739-43, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18670746

RESUMEN

BACKGROUND: Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT). AIM: To investigate the financial implications of scan-directed parathyroid surgery. METHODS: Analysis of hospital records for a cohort of consecutive unselected patients treated in a tertiary referral centre. RESULTS: Two hundred patients (138F:62M, age 18-91years) were operated for non-familial PHPT between Jan 2003 and Oct 2007. MIP was performed in 129 patients, with a mean operative time was 35 +/- 18min. Some 75 patients were discharged the same day and the others had a total of 72 in-patient days. Bilateral neck exploration (BNE) was performed in 71 patients with negative/non-concordant scans. Mean operative time was 58 +/- 25min. Only nine patients were discharged the same day and a total of 93 in-patient days were used ( approximately 1.3days/patient). The estimated total costs incurred were pound215,035 ( approximately 290,000). These costs would have been covered by the National Tariff ( pound2,170 per parathyroidectomy) but were higher than those possibly incurred if all 200 patients would have undergone BNE without any radiological investigations ( pound166,000 approximately 224,100euro). CONCLUSION: Shorter operative time and day-case admission for MIP generate costs savings that compensate only partially for the additional costs associated with parathyroid imaging studies.


Asunto(s)
Hiperparatiroidismo Primario/economía , Hiperparatiroidismo Primario/cirugía , Tiempo de Internación/economía , Procedimientos Quirúrgicos Mínimamente Invasivos/economía , Paratiroidectomía/economía , Cintigrafía/economía , Ultrasonografía/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Análisis Costo-Beneficio , Femenino , Costos de Hospital/estadística & datos numéricos , Humanos , Hiperparatiroidismo Primario/diagnóstico , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/economía , Neoplasias Primarias Múltiples/cirugía , Hormona Paratiroidea/sangre , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/cirugía , Sensibilidad y Especificidad , Tecnecio Tc 99m Sestamibi , Adulto Joven
8.
Clin Otolaryngol ; 33(2): 134-7, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18429868

RESUMEN

Parathyroid hormone has a short half life in vivo. Intraoperative parathyroid hormone measurement can guide the surgeon by confirming successful removal of parathyroid adenomas. Point of care testing with a dedicated analyser and technician in theatre is expensive. This study shows that intraoperative parathyroid hormone is feasible using a central laboratory based analyser available in most hospitals. There are potential cost savings when compared with point of care testing.


Asunto(s)
Adenoma/cirugía , Monitoreo Intraoperatorio/instrumentación , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/instrumentación , Adenoma/economía , Adenoma/patología , Adulto , Anciano , Costos y Análisis de Costo , Diseño de Equipo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/economía , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/patología , Paratiroidectomía/economía , Estudios Prospectivos
9.
Surgery ; 133(1): 32-9, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12563235

RESUMEN

BACKGROUND: Radionuclide imaging-directed, minimally invasive parathyroid operation is promoted in the surgical literature and public domain as the fastest, most successful, and cheapest means of treating primary idiopathic hyperparathyroidism. The validity of these claims is unproven. This study reviews the treatment outcome results of a large series of patients treated with standard parathyroid operation without preoperative localization studies. Cost comparisons are made between this series and previous reports of selected patients in whom preoperative radionuclide imaging preceded minimally invasive parathyroid operation. METHODS: Diagnosis, treatment, and outcome data for 688 consecutive patients undergoing first neck exploration for primary idiopathic hyperparathyroidism were prospectively collected. All patients in our series underwent standard bilateral neck exploration without preoperative localization studies. Intraoperative methylene blue was used to aid identification of all parathyroid glands. Surgical findings, pathological diagnosis, operative time, length-of-stay, and treatment success data were collected. Cost data were calculated for our series using the identical calculations used in previous reports. Our outcome and calculated cost data were compared with previous reports by centers advocating scan-directed, minimally invasive parathyroid operation. RESULTS: Of 2,752 predicted total glands, 2,520 (91.6%) were identified using standard neck exploration without radionuclide localization studies. Single adenoma, with at least 1 normal gland, was found in 542 patients (78.8%), with 8 in a fifth gland. Multiple-gland hyperplasia was identified in 98 patients (14.2%) and of these 22 (3.2%) were double adenomas. Ten patients had parathyroid carcinoma (1.5%), and all received definitive surgical treatment during the primary operation. Cure rates were assessed by measurement of normal serum calcium and parathyroid hormone levels at 3 and 12 months after operation, and were 97.7% in our series. Mean operating time for the entire series was 65 minutes, decreased to 35 minutes in patients with single adenomas, and mean recovery room time was 30 minutes. Mean total costs for patients undergoing standard exploration for single adenoma was US dollars 1,107, and increased to US dollars 1,243 when patients with multigland disease, hyperplasia, or malignancy were included. CONCLUSIONS: Our series demonstrates operative times and treatment outcomes with costs that are approximately one-third less than those for scan-directed, minimally invasive operation for primary idiopathic hyperparathyroidism. Thus, claims that scan-directed parathyroid operation is the cheapest, fastest, and most successful means of treatment are not supported by these data.


Asunto(s)
Costos de Hospital , Hiperparatiroidismo/economía , Hiperparatiroidismo/cirugía , Evaluación de Resultado en la Atención de Salud , Procedimientos Quirúrgicos Operativos/economía , Adenoma/diagnóstico por imagen , Adenoma/economía , Adenoma/cirugía , Ahorro de Costo , Estudios de Seguimiento , Humanos , Hiperparatiroidismo/diagnóstico por imagen , Procedimientos Quirúrgicos Mínimamente Invasivos , Cuello/cirugía , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/cirugía , Estudios Prospectivos , Cintigrafía
10.
Otolaryngol Head Neck Surg ; 121(4): 393-7, 1999 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-10504594

RESUMEN

The surgical treatment of hyperparathyroidism has become controversial with the recent advent of reliable preoperative imaging modalities. This study examines the efficacy and economy of using preoperative imaging studies to localize the pathology and allow for unilateral neck exploration. From January 1990 to May 1996, a total of 91 patients with primary hyperparathyroidism were treated at Swedish Medical Center in Seattle, WA, by 2 surgeons. Eighty-six nuclear scintigraphy studies were performed, of which 44 were technetium 99m sestamibi (Tc-99m-sestamibi) scans and 42 were thallium 99m technetium (Th-99m-Tc) scans. The overall sensitivity for Tc-99m-sestamibi was 91% (40/44), and that for Th-99m-Tc scans was 81% (34/42). Ultrasound examination revealed a sensitivity of 80% (66/82). There was a statistically significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes, P < 0.0001). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypercalcemia 93% (85/91) of the time with the use of preoperative imaging studies. Tc-99m-sestamibi is a reliable tool for planning the initial unilateral neck exploration for treatment of primary hyperparathyroidism.


Asunto(s)
Adenoma/cirugía , Diagnóstico por Imagen , Hiperparatiroidismo/cirugía , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Adenoma/diagnóstico , Adenoma/economía , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Diagnóstico Diferencial , Diagnóstico por Imagen/economía , Femenino , Humanos , Hiperparatiroidismo/diagnóstico , Hiperparatiroidismo/economía , Hiperplasia , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/patología , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/economía , Paratiroidectomía/economía , Sensibilidad y Especificidad
11.
Am Surg ; 64(6): 503-7; discussion 507-8, 1998 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-9619169

RESUMEN

Published data is controversial as to the ability of preoperative localization studies (PLS) to enhance the outcome of initial cervical exploration in patients with primary hyperparathyroidism (PHPT). One surgeon's experience was reviewed to compare surgical success, operative time, and morbidity of initial cervical exploration for PHPT in patients who had undergone PLS versus those who had not. From August 1991 to September 1997, 95 patients who had not undergone prior central cervical exploration presented for surgical management of PHPT. Sixty-seven patients underwent initial cervical exploration without any PLS having been performed (Group A). Twenty-eight patients underwent PLS, either alone or in combination, before surgical intervention (Group B). Analysis of intergroup variability was conducted upon the data available using a two-tailed t test for independent samples. In addition, the sensitivities and positive predictive values of the PLS were calculated using study reports and operative and histologic findings. There was no statistically significant difference in surgical success between those patients who had PLS and those that did not undergo PLS. Sixty-four of 67 patients (95.5%) not having PLS were cured with initial surgery, while 27 of 28 patients (96.4%) who had PLS were surgically cured. Mean postoperative calcium and intact parathormone levels were similar between the two groups, and the mean operative time did not differ. Permanent hypocalcemia occurred in one patient, and five patients had transient hoarseness. Thirty-six total PLS were obtained at an average cost of $752.68/patient, and seven patients underwent multiple tests. Overall, sestamibi scan had the highest positive predictive value (81%). For adenomatous disease alone, sestamibi scan was the most sensitive (83%). Our study shows that for matched groups limited to age, sex, and clinical diagnosis, the use of PLS did not shorten operative time, decrease complication frequency, nor alter the success of the operation as measured by postoperative calcium and parathormone levels. Therefore, routine use of preoperative localization studies before initial cervical exploration for PHPT cannot be recommended.


Asunto(s)
Adenoma/cirugía , Diagnóstico por Imagen/economía , Hiperparatiroidismo/cirugía , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/economía , Adenoma/diagnóstico , Adenoma/economía , Anciano , Ahorro de Costo , Femenino , Humanos , Hiperparatiroidismo/diagnóstico , Hiperparatiroidismo/economía , Masculino , Persona de Mediana Edad , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/economía , Sensibilidad y Especificidad , Resultado del Tratamiento , Procedimientos Innecesarios/economía
12.
J Am Coll Surg ; 186(3): 293-305, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9510260

RESUMEN

BACKGROUND: In 1991, a National Institutes of Health Consensus Panel stated that preoperative localization for primary hyperparathyroidism is not cost effective. Since then, the sestamibi scan has been applied to parathyroid disease with excellent results, even allowing unilateral exploration under local anesthesia. STUDY DESIGN: A metaanalysis of the English literature over the past 10 years was performed to determine the collective sensitivity and specificity of sestamibi scanning to establish its utility in directing a unilateral procedure. The cost effectiveness of scanning all patients with sporadic primary hyperparathyroidism was examined by determining the costs of seven operative technique-dependent variables that could be reduced with a limited procedure. RESULTS: The average sensitivity and specificity of sestamibi were 90.7% and 98.8%, respectively, indicating its ability to guide an accurate unilateral exploration. The analysis of 6,331 patients showed that 87% had solitary adenomas. An average cost savings of $650 was demonstrated for a unilateral operation, which could be realized in as many as 90% (sestamibi sensitivity) of those with solitary adenomas. CONCLUSIONS: A preoperative sestamibi scan is specific enough in identifying solitary adenomas to allow unilateral exploration with a < 1% failure rate. The sensitivity of this scan suggests that 78% of all patients with sporadic primary hyperparathyroidism (90% of the 87% with solitary adenomas) are candidates for unilateral exploration. This rate is significantly higher than the 51% rate at which scanning all patients becomes cost effective.


Asunto(s)
Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Paratiroidectomía/métodos , Radiofármacos/economía , Tecnecio Tc 99m Sestamibi/economía , Adenoma/diagnóstico por imagen , Adenoma/economía , Adenoma/cirugía , Análisis Costo-Beneficio , Humanos , Hiperparatiroidismo/economía , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/economía , Neoplasias de las Paratiroides/cirugía , Selección de Paciente , Cuidados Preoperatorios/economía , Cintigrafía , Sensibilidad y Especificidad
13.
Curr Opin Gen Surg ; : 108-14, 1993.
Artículo en Inglés | MEDLINE | ID: mdl-7583938
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA