Outpatient Parathyroidectomy is Safe and Effective: A 7-year Review

Background Minimally-invasive parathyroidectomy (MIP) techniques have made the procedure safer and more feasible as an outpatient parathyroidectomy (OP). We hypothesized that any type of parathyroidectomy is safe as an outpatient procedure and strive to characterize factors responsible for successful OP. Methods A retrospective analysis was performed of all parathyroidectomies between August 2009 and October 2016 with or without thyroidectomy to identify the type of parathyroid surgery, inpatient parathyroidectomy (IP) vs. OP status, postoperative complications, and resulting clinical outcomes. Results There were 672 parathyroidectomies, 51 IP (7.6%) and 621 OP (92.4%), consisting of 456 focused parathyroidectomies consisting of 1-2 gland resections (P) (67.9%), 68 subtotal parathyroidectomies consisting of 3-3.5 gland resections (SP) (10.1%), 125 P with thyroidectomy (PT) (18.6%), and 23 SP with thyroidectomy (SPT) (3.4%). Anesthesia included 369 (54.9%) under general (GA) and 294 (43.8%) under local anesthesia with monitored anesthesia care (L/MAC). IP experienced more symptomatic hypocalcemia than OP (13.7% vs. 4.3%) (p = 0.01). Symptomatic hypocalcemia was more common after SP (16.2%) or SPT (17.4%) than P (2.2%) or PT (7.2%) (p < 0.0001) and with GA (8.1%) than L/MAC (1.0%) (p < 0.0001). OP had a lower American Society of Anesthesia (ASA) score (2.5 mean) than IP (3.2 mean) (p < 0.0001). Three (5.9%) recurrent laryngeal nerve (RLN) injuries occurred with IP and six (1.0%) with OP (p = 0.02) with only one permanent OP injury (0.16%). RLN injury had no significant association with the extent of surgery (P, SP, PT, and SPT), age, sex or type of anesthesia. One OP postoperative hematoma occurred (0.16%) with a PT. There were no mortalities. Average OP postoperative time to discharge was 2.2 hours. Conclusion Outpatient parathyroid surgery is safe and should be applicable to nearly all patients, except those needing more extensive parathyroidectomy/thyroidectomy surgery or patients with greater comorbidities.