Quality of Life and Patient Satisfaction after Reoperation for Primary Hyperparathyroidism: Analysis of Long‐term Results

Abstract

Morbidity after reoperation for persistent or recurrent primary hyperparathyroidism (pHPT) is higher than after primary surgery. According to our experience, there is a contrast between postoperative normalization of laboratory parameters and the quality of life/patient satisfaction after reoperation. Therefore the aim of the study was to analyze the outcomes of reoperations in comparison to primary surgery. We evaluated the patients' reported quality of life using the SF-36 (an accepted health status assessment tool) and complete prospectively documented perioperative and follow-up data including postoperative complications. Additionally, we searched for reasons why primary surgical intervention did not succeed. In a prospective cohort study the perioperative data of 653 consecutive patients with pHPT, including 75 reoperated patients (11.5%) who underwent parathyroidectomy between 1987 and 1999, were evaluated by uni- and multivariate analysis. At a median 78 months (6-156 months) postoperatively, all patients underwent a planned follow-up that included the SF-36, physical examination, and laboratory investigations. A total of 51 reoperated patients were available for follow-up. Postoperative alleviation of symptoms or being symptom-free was reported by 70.6%. Patients after reoperation had lower SF-36 scores in all health domains postoperatively than patients after a primary operation. Of the reoperated patients, 19.6% stated that after evaluating the development of their complaints they would not consent to reoperation again. Subgroup analysis showed that 80% of patients with postoperatively persistent pHPT, 60% of those who did not observe symptom alleviation, and 44% of those after sternotomy were in the group of dissatisfied patients. Surprisingly, none of the patients with more than one reoperation, only two of the five patients with permanent recurrent laryngeal nerve injury, and only one of the four patients with persistent hypoparathyroidism were dissatisfied overall. Parathyroidectomy resulted in normocalcemia in 90.2% of the reoperated patients, with an operative morbidity of 27.4% and no mortality. After an unsuccessful operation for pHPT, patients should be treated at an expert center to avoid persistent hypercalcemia. Reoperations necessitating sternotomy should be restricted to patients with severe symptoms and signs.

Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations

“…Reoperations for persistent and recurrent HPT represent 12-20% of all parathyroid operations in referral centers [65,66]. Reoperations are challenging because of tissue scarring, multiglandular disease, and/or presence of ectopic glands.…”

Imaging of the parathyroid glands in primary hyperparathyroidism

“…Indeed, reoperation is associated with a potential threefold increase in morbidity and a risk of low curative rate. This is mainly due to distortion and scarring of surgical planes caused by the initial surgery (29).…”

Perioperative changes in cortical excitability, mood, and quality of life in patients with primary hyperparathyroidism: a pilot study using transcranial magnetic stimulation

“…Motor-evoked potentials (MEP) were recorded using surface EMG Ag/AgCl electrodes placed over the right abductor digiti minimi muscle using a belly-tendon montage. The raw signal was amplified, filtered (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and recorded with a PC using a commercially available data-collection and averaging program (Magnetix, Centre of Sensorimotor Research, Munich, Germany) for offline analysis. The optimal coil placement was determined by recording MEP while varying the coil position.…”

“…Primary HPT (pHPT) consists of continually elevated serum calcium and PTH levels (11), mostly due to a solitary parathyroid adenoma (1,11,12). The only curative treatment for pHPT is the resection of the suspected solitary adenoma(s) or hyperplastic glands (parathyroidectomy (PTx)) to reestablish normocalcemia which may lead to improved quality of life (13,14). Several case reports show higher amplitudes in somatosensory-evoked potentials (8), electro encephalography (EEG)-alterations, reversible vasoconstriction, and epileptic seizures (9,15,16) or even (nonconvulsive) SE (10) in patients with hypercalcemia.…”