Objective:
To characterize contemporary management practices of primary, secondary, and tertiary hyperparathyroidism among North American surgeons, focusing on the use of intraoperative parathyroid hormone monitoring and imaging techniques.
Approach:
- 88% of surgeons reported using intraoperative parathyroid hormone monitoring (IOPTH) during parathyroid surgery.
- Use of IOPTH was higher among US surgeons (98%) compared to Canadian (69%) and other regions (67%).
- IOPTH was most frequently used in primary hyperparathyroidism (92%), followed by tertiary (77%) and secondary (76%) hyperparathyroidism.
- 64% of surgeons treating primary hyperparathyroidism used Miami or modified Miami criteria for decision-making.
- Ultrasonography was the most common imaging modality reported across all hyperparathyroidism types, with specific percentages for each type.
- Surgeons reported using IOPTH (44%) and frozen section analysis (39%) as the most common intraoperative adjuncts.
- Cross-sectional design may limit causal inferences.
- Overrepresentation of US, academic, and English-speaking surgeons may affect generalizability, potentially skewing the results.
Key Findings:
Interpretation:
Surgeons generally adhere to clinical guidelines for primary hyperparathyroidism, but there is less consensus in secondary and tertiary cases, indicating variability in practice that may impact patient outcomes.
Limitations:
Conclusion:
While adherence to clinical recommendations is strong, significant practice heterogeneity exists in imaging and intraoperative technologies, particularly in renal hyperparathyroidism, highlighting the need for standardized guidelines.
Sources:
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