Outcomes and Economic Analysis of Routine Preoperative 4-Dimensional CT for Surgical Intervention in de novo Primary Hyperparathyroidism: Does Clinical Benefit Justify the Cost?

• Published in: Journal of the American College of Surgeons Vol. 214; no. 4; pp. 629 - 637
• Main Authors: Abbott, Daniel E., MD, Cantor, Scott B., PhD, Grubbs, Elizabeth G., MD, FACS, Santora, Rachel, MD, Gomez, Henry F., MD, Evans, Douglas B., MD, FACS, Lee, Jeffrey E., MD, FACS, Vu, Thinh, MD, Perrier, Nancy D., MD, FACS
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2012; Elsevier
• Subjects: Biological and medical sciences; Cost-Benefit Analysis; Decision Trees; Endocrinopathies; Four-Dimensional Computed Tomography - economics; General aspects; Hospital Costs; Humans; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - economics; Hyperparathyroidism, Primary - surgery; Length of Stay - economics; Length of Stay - statistics & numerical data; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - economics; Miscellaneous; Models, Statistical; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroidectomy - economics; Parathyroidectomy - methods; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Preoperative Care - economics; Preoperative Care - methods; Public health. Hygiene; Public health. Hygiene-occupational medicine; Surgery; Texas; Time Factors; Treatment Failure; Treatment Outcome; minimally invasive parathyroidectomy; 4DCT; Current Procedural Terminology; 4-dimensional CT; MIP; CPT; Endocrinopathy; Economic analysis; Costs; Prognosis; Radiodiagnosis; Clinical benefit; Routine analysis; De novo; Medicine; Treatment; Parathyroid diseases; Surgery; Health economy; Primary; Medical imagery; Evolution; Computerized axial tomography; Economic aspect; Preoperative; Hyperparathyroidism; Public health
• ISSN: 1072-7515; 1879-1190; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2011.12.022

Background Preoperative imaging in patients with primary hyperparathyroidism provides important localization information. Although 4-dimensional neck CT (4DCT) can precisely localize hyperfunctioning parathyroid tissue, the contribution of 4DCT to overall cost, operating room time, and hospital stay is unknown. Study Design Records of 535 patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution from 1996 to 2010 were reviewed. All patients had preoperative cervical ultrasonography and sestamibi scanning, and most (78.9%) underwent preoperative 4DCT. A decision tree was constructed to compare extent of procedure, operating room time, length of stay, failure rate, and total cost of each strategy (with and without 4DCT). Costs were determined by 2010 Medicare reimbursement. Results For patients with and without preoperative 4DCT, respectively, mean operating room time (64.4 vs 61.4 minutes; p = 0.58) and failure rate (1.9% vs 4.4%; p = 0.12) were not significantly different. Length of stay was higher in the no-CT cohort (0.61 vs 0.23 days; p < 0.001). Patients with a preoperative 4DCT were significantly more likely to undergo a limited parathyroidectomy (90.3% vs 80.5%; p = 0.004). Mean cost of care per patient in the CT and no-CT cohorts was $6,572 and $6,306, respectively. Conclusions The introduction of routine 4DCT into the preoperative workup for surgical intervention in primary hyperparathyroidism does not appear to shorten operating room time or decrease failure rate significantly. However, preoperative 4DCT is associated with shorter hospital stays and improved rates of minimally invasive parathyroidectomy. This clinical benefit must be weighed against the increased cost associated with routine preoperative 4DCT.