Effects of preoperative parathyroid localisation studies on the cost of operations for persistent hyperparathyroidism.

OBJECTIVE To find out whether preoperative parathyroid localisation studies are cost-effective in patients with persistent hyperparathyroidism (HPT). DESIGN Retrospective study. SETTING University hospital, Sweden. PATIENTS 29 consecutive patients with persistent HPT who were reoperated on with or without localisation studies. 15 other patients had initial operations for HPT without localisation studies. INTERVENTIONS Initial or repeat operation for HPT, localisation studies with 99mTc sestamibi scintigraphy, and catheterisation of large cervical and mediastinal veins with measurements of serum concentrations of parathyroid hormone. MAIN OUTCOME MEASURES Operative time. Cost of operations, frozen section biopsy and localisation studies. RESULTS The mean durations of reoperation with localisation studies and for the initial operation without them, were 124 and 135 minutes, respectively, while it was 269 minutes for reoperation without studies. For patients who had localisation studies the mean total cost of the investigations, operating time, and frozen section biopsy was 28% less than for patients who were reoperated on without such studies. CONCLUSION Preoperative localisation studies before repeat operations for HPT were cost-effective. Even if it has not been shown in this series, the reduction in operating time and the extent of dissection by localisation studies has the potential to decrease morbidity.