Compliance with recommendations on surgery for primary hyperparathyroidism-from guidelines to real practice: results from an Iberian survey
Por:
Villar-del-Moral, J, Capela-Costa, J, Jimenez-Garcia, A, Sitges-Serra, A, Casanova-Rituerto, D, Rocha, J, Martos-Martinez, J, de la Quintana-Basarrate, A, Rosa-Santos, J, Guirao-Garriga, X, Bravo-de-Lifante, J, Vidal-Perez, O, Moral-Duarte, A, Polonia, J
Publicada:
1 nov 2016
Resumen:
Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes.
An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions.
Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038).
Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.
Filiaciones:
Villar-del-Moral, J:
Virgen Ias Nieves Univ Hosp, Endocrine Surg Div, Dept Surg, Ave Fuerzas Armadas 2, Granada 18014, Spain
Capela-Costa, J:
So Joo Univ Hosp, Endocrine Surg Div, Dept Surg, Alameda Prof Hernani Monteiro, P-4200319 Alameda, CA, Portugal
Jimenez-Garcia, A:
Virgen Macarena Univ Hosp, Endocrine Surg Div, Dept Surg, Ave Doctor Fedriani 3, Seville 41009, Spain
Sitges-Serra, A:
Hosp Mar, Endocrine Surg Div, Dept Surg, Passeig Maritim 25-29, Barcelona 08003, Spain
Casanova-Rituerto, D:
Marques Valdecilla Univ Hosp, Endocrine Surg Div, Dept Surg, Ave Valdecilla S-N, Santander 39008, Spain
Rocha, J:
Santa Maria Univ Hosp, Endocrine Surg Div, Dept Surg, Avenida Prof Egas Moniz, P-1600190 Lisbon, Portugal
Martos-Martinez, J:
Virgen Rocio Univ Hosp, Endocrine Surg Div, Dept Surg, Ave Manuel Siurot S-N, Seville 41013, Spain
de la Quintana-Basarrate, A:
Cruces Univ Hosp, Endocrine Surg Div, Dept Surg, Plaza Cruces 12, Baracaldo 48903, Spain
Rosa-Santos, J:
IPO Lisboa, Head & Neck Surg Serv, R Prof Lima Basto, P-1099023 Lisbon, Portugal
Guirao-Garriga, X:
Parc Tauli Hosp, Endocrine Surg Div, Dept Surg, Parc Tauli 1, Sabadell 08208, Spain
Bravo-de-Lifante, J:
Princesa Univ Hosp, Endocrine Surg Div, Dept Surg, Calle Diego Leon 62, Madrid 28006, Spain
Vidal-Perez, O:
Clin Univ Hosp, Endocrine Surg Div, Dept Surg, Carrer Villarroel 170, Barcelona 08036, Spain
Moral-Duarte, A:
Santa Creu I Sant Pau Univ Hosp, Endocrine Surg Div, Dept Surg, Carrer Sant Quinti 89, Barcelona 08026, Spain
Polonia, J:
Hosp Santo Antonio, Largo Prof Abel Salazar, P-4099001 Oporto, Portugal
|