scholarly journals EP.WE.381Daycase Parathyroidectomy for Primary Hyperparathyroidism: Our Experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
P A Jayawardena ◽  
P D Turner ◽  
V D Shetty
Keyword(s):  
Primary Hyperparathyroidism ◽  
Postoperative Recovery ◽  
Complication Rates ◽  
Parathyroid Surgery ◽  
Patient Support ◽  
Readmission Rates ◽  
Information Leaflets ◽  
Overnight Stay ◽  
Hospital Transport ◽  
Surgical Clinic

Abstract Aims Concerns due to postoperative complications following parathyroid surgery have precluded its consideration as a Daycase procedure. However recent BAETS guidelines have supported Daycase parathyroid surgery. To assess the outcomes of Daycase parathyroidectomy pathway we established in our Hospital since April,2018. Methods Retrospective review of all patients who underwent parathyroidectomy for Primary Hyperparathyroidism between April,2018 and October,2020. Patients with ASA 3 and above and patients undergoing total-parathyroidectomies were excluded. Outcome measures include length of stay, prerequisite for overnight stay, complications, and readmission rates. All patients were assessed and counselled for suitability for Daycase in surgical clinic and given detailed information leaflets. Results In this period, 40patients underwent surgery for primary hyperparathyroidism. Of these, 30 patients (75%), 8 males and 22 females with a median age of 59years fulfilled the criteria for Daycase surgery. 19 patients (63.3%) were successfully discharged on the day of surgery. 11 patients (36.7%) were discharged the following morning. The reasons for overnight stay are - 5patien ts(16.7%) developed post-anaesthetic nausea and drowsiness; in 5patients(16.7%) surgery started after 2pm and delayed postoperative return to ward lead to inadequate time for safe discharge; 1patient(3.3%) needed hospital transport. The readmission and postoperative complication rates were nil. Conclusions Daycase parathyroidectomy is safe in carefully selected patients. Adequate preoperative counselling, robust perioperative management to minimize postop morbidity and clear patient support package upon discharge are vital for wider acceptance. All Daycase patients should be operated first on the list and prior to 2pm to ensure safe discharge allowing adequate time for postoperative recovery.

Outpatient Parathyroid Surgery: Ten-Year Experience: Is it Safe?

2015 ◽  
Vol 81 (5) ◽  
pp. 472-477 ◽  
Author(s):  
Michael B. Flynn ◽  
Mohiuddin Quayyum ◽  
Richard E. Goldstein ◽  
Jeffery M. Bumpous
Keyword(s):  
Minimally Invasive ◽  
Outpatient Surgery ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Parathyroid Surgery ◽  
Readmission Rates ◽  
Systemic Complications ◽  
Careful Patient ◽  
Systemic Complication ◽  
Outpatient Operations

Outpatient parathyroid surgery is increasing in frequency especially for patients undergoing minimally invasive operations. From January 1, 2000 to December 31, 2009, 585 operations were performed on patients with untreated primary hyperparathyroidism. Outpatient operations were performed on 43 per cent (249/585), whereas 57 per cent (336/585) were admitted. Comorbidities were present in 63 per cent of outpatients and 72 per cent of inpatients, whereas systemic complications occurred in 0.8 per cent of outpatients and 7 per cent of inpatients. Ninety-four per cent of outpatients were minimally invasive although inpatient procedures were evenly divided. Local complications were low (8% and 6%) in both groups. Using zip codes to determine distance from home to hospital, no differences were noted. Readmission rates were low (< 0.5%) and the same in each group. Inpatients longer than 23 hours tended to be older with higher local and systemic complication rates. Over a decade, most patients undergoing same day parathyroid surgery had minimally invasive operations with lower comorbidities and lower systemic complications than inpatients. Minimally invasive and less complex nonminimally invasive operations can safely be performed on an outpatient basis with careful patient selection. Patient with more severe comorbidities and multiple comorbidities are less favorable candidates for outpatient surgery because of a higher risk of systemic complications.

scholarly journals 845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S A Joiya ◽  
M Hamid ◽  
Z Siddiqui
Keyword(s):  
Learning Curve ◽  
Skill Acquisition ◽  
Postoperative Recovery ◽  
Task Completion ◽  
Complication Rates ◽  
Novice Group ◽  
Surgical Trainees ◽  
Long Duration ◽  
Hospital Stays ◽  
Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

scholarly journals Erratum to: A Predictive Model of Suitability for Minimally Invasive Parathyroid Surgery in the Treatment of Primary Hyperparathyroidism

2012 ◽  
Vol 36 (5) ◽  
pp. 1174-1174
Author(s):  
Dara O. Kavanagh ◽  
Patricia Fitzpatrick ◽  
Eddie Myers ◽  
Rory Kennelly ◽  
Stephen J. Skehan ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Predictive Model ◽  
Parathyroid Surgery

scholarly journals Focus on the totally laparoscopic feeding gastrostomy tube placement operative technique

2021 ◽  
Vol 9 (1) ◽  
pp. 127-133
Author(s):  
Sorin Cimpean ◽  
Alexandre Grapotte ◽  
Nicolas Boyer ◽  
Mathilde Poras ◽  
Dario Raglione ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Feeding Tube ◽  
Tube Placement ◽  
Laparoscopic Technique ◽  
Complication Rates ◽  
Readmission Rates ◽  
Gastric Lumen ◽  
Gastrostomy Tube Placement ◽  
Totally Laparoscopic ◽  
The Cost

Laparoscopic feeding gastrostomy placement is a surgical operation that allows the feeding of malnourished patients through a tube that is placed in the gastric lumen. The benefits of an improved nutritional status in terms of improving clinical outcomes are well documented in the literature and consist in a reduction of the complication rates of the surgical patients, the length of hospital stay, the readmission rates, and a reduction of the cost of health services by reducing the morbidity or mortality. We present a totally laparoscopic technique of feeding tube placement.

scholarly journals Night Sweats as the Presenting Symptom of Primary Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A207-A207
Author(s):  
Vanessa Williams ◽  
Hadoun Jabri ◽  
Michael G Jakoby
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Vasomotor Symptoms ◽  
Temperature Threshold ◽  
Hot Flushes ◽  
Parathyroid Surgery ◽  
Intact Pth ◽  
Patient Reported ◽  
Night Sweats

Abstract Background: Approximately 25–40% of patients report night sweats in the previous month during appointments with their primary care clinicians. The differential diagnosis for night sweats is broad, with hyperthyroidism, carcinoid syndrome, pheochromocytoma, medullary thyroid carcinoma, insulinoma, and acromegaly as established endocrine causes. We present a case of primary hyperparathyroidism (PHPT) in which the patient’s chief complaint was night sweats and resolution occurred after parathyroidectomy. Case. A 39-year-old female reported one-year of daily night sweats that required changes of clothes and bedding. She denied excessive daytime sweating, frequent palpitations, tremors, nightmares, rashes, fevers, chills, cough, headaches, dizziness, abdominal pain, diarrhea, disrupted menses, or unintentional weight loss. Vital signs and examination were unremarkable. Hypercalcemia (11.0 mg/dL, 8.6–10.3) was noted and confirmed by additional serum calcium measurements. Intact PTH ranged from 27–33 pg/mL (12–88), and 24 h urine calcium (258 mg) excluded familial hypocalciuric hypercalcemia (FHH). Parathyroid scintigraphy and neck ultrasound identified a left neck mass, and the patient underwent successful resection of a left inferior parathyroid adenoma. Hypercalcemia and night sweats initially resolved after surgery, but the patient returned six weeks later with recurrence of night sweats. Reevaluation was notable for serum calcium 10.4 mg/dL, phosphorus 2.4 mg/dL (2.5–5.0), and intact PTH 104 pg/mL. A right superior parathyroid adenoma was identified on repeat parathyroidectomy, and the patient experienced durable resolution of night sweats and hypercalcemia following her second parathyroid surgery. She was screened for multiple endocrine neoplasia type 1 (MEN1) due to multiple parathyroid tumors, though no known pathogenic menin gene variants were identified. Conclusions: A title/abstract search in PubMed linking “hyperparathyroidism” and “hypercalcemia” to “night sweats,” “sleep hyperhidrosis,” “sweating,” “hot flashes,” “hot flushes,” “diaphoresis” and “vasomotor symptoms” yielded only one relevant case of a postmenopausal woman with hot flushes unresponsive to hormone replacement that resolved after parathyroidectomy for PHPT. Hypercalcemia is known to affect central nervous system function. It is possible that in rare cases hypercalcemia alters function of the medial preoptic area, lowering the temperature threshold above which peripheral vasodilatation and perspiration occur to dissipate heat. The patient’s predisposition to only night sweats is unclear, though unlike the first patient reported with PHPT and sweating, our patient is premenopausal. This case indicates that vasomotor symptoms may occur with PHPT and resolve after successful parathyroid surgery.

scholarly journals Effect of Social Support and Marital Status on Perceived Surgical Effectiveness and 30-Day Hospital Readmission

2017 ◽  
Vol 7 (8) ◽  
pp. 774-779 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Social Support ◽  
Hospital Stay ◽  
Marital Status ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Complication Rates ◽  
Readmission Rates ◽  
Outcomes Measures ◽  
Significant Difference ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery. Methods: The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form–36, and visual analog scale–back pain/leg pain) were completed before surgery, then at 1 year after surgery. Results: Baseline characteristics were similar in all cohorts. There was no statistically significant difference in the length of hospital stay across all 3 cohorts, although “single patients” had longer duration of in-hospital stays that trended toward significance (single 6.24 days vs married 4.53 days vs divorced/separated/widowed 4.55 days, P = .05). Thirty-day readmission rates were similar across all cohorts (married 7.03% vs divorced/separated/widowed 7.04% vs single 6.52%, P = .99). Additionally, there were no significant differences in baseline and 1-year patient reported outcomes measures between all groups. Conclusions: Increased social support did not appear to be associated with superior short and long-term clinical outcomes after spine surgery; however, it was associated with a shorter duration of in-hospital stay with no increase in 30-day readmission rates.

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