Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA.
Ann Surg. 2015 Apr;261(4):746-50. doi: 10.1097/SLA.0000000000000812.
To examine trends in the frequency and quality of surgery for primary hyperparathyroidism (PHPT) in California during the period of 1999 to 2008.
The quality of surgery for PHPT can be measured by the complication rate and the success rate of surgery. A fraction of patients with failed initial surgery undergo reoperation.
Data on patients undergoing parathyroidectomy (PTx) were obtained from the California Office of Statewide Health Planning and Development. Renal transplant recipients and dialysis patients were excluded. Hospitals were categorized by case volume: Very low: 1 to 4 operations annually; Low: 5 to 9; Medium, 10 to 19; High: 20 to 49; Very high: 50 or more. Complication rates and the percentage of cases requiring reoperation were analyzed.
A total of 17,082 cases were studied. Annual case volume grew from 990 to 2746 (177% increase) over the study period, corresponding to a 147% increase in the per capita PTx rate. The proportion of cases performed by very high-volume hospitals increased from 6.4% to 20.5% (P < 0.001). The overall complication rate declined from 8.7% to 3.8% (P < 0.001). Complication rates were inversely related to hospital volume (very high volume, 3.9% vs very low volume, 5.2%, P < 0.05). Reoperation was performed in 363 patients (2.1%). The reoperation rate increased from 0.91% to 2.73% during the study period (P < 0.01). The reoperation rate was inversely and nonlinearly related to hospital volume, as described by the equation % reoperation = 100/(total hospital case volume).
Surgery for PHPT has grown safer and more common over time. High-volume centers have lower rates of complication and reoperation.
研究 1999 年至 2008 年期间加利福尼亚州原发性甲状旁腺功能亢进症（PHPT）手术频率和质量的趋势。
甲状旁腺功能亢进症手术的质量可以通过并发症发生率和手术成功率来衡量。一部分初次手术失败的患者需要再次手术。
从加利福尼亚州全州卫生规划和发展办公室获得甲状旁腺切除术（PTx）患者的数据。排除肾移植受者和透析患者。根据手术量对医院进行分类：非常低：每年 1 至 4 例；低：5 至 9 例；中：10 至 19 例；高：20 至 49 例；非常高：50 例或更多。分析并发症发生率和需要再次手术的病例比例。
共研究了 17082 例病例。在研究期间，年手术量从 990 例增加到 2746 例（增长 177%），相应的人均 PTx 率增长了 147%。由高容量医院进行的病例比例从 6.4%增加到 20.5%（P<0.001）。总体并发症发生率从 8.7%降至 3.8%（P<0.001）。并发症发生率与医院容量呈反比（高容量，3.9%比低容量，5.2%，P<0.05）。363 例患者（2.1%）进行了再次手术。在此期间，再次手术率从 0.91%增加到 2.73%（P<0.01）。再次手术率与医院容量呈反比且非线性关系，如方程%再次手术=100/（医院总手术量）所示。
随着时间的推移，PHPT 的手术治疗变得更加安全和普遍。高容量中心的并发症和再次手术率较低。
