Trends in the frequency and quality of parathyroid surgery: analysis of 17,082 cases over 10 years.

摘要: OBJECTIVE To examine trends in the frequency and quality of surgery for primary hyperparathyroidism (PHPT) California during period 1999 to 2008. BACKGROUND The PHPT can be measured by complication rate success surgery. A fraction patients with failed initial undergo reoperation. METHODS Data on undergoing parathyroidectomy (PTx) were obtained from Office Statewide Health Planning Development. Renal transplant recipients dialysis excluded. Hospitals categorized case volume: Very low: 1 4 operations annually; Low: 5 9; Medium, 10 19; High: 20 49; high: 50 or more. Complication rates percentage cases requiring reoperation analyzed. RESULTS total 17,082 studied. Annual volume grew 990 2746 (177% increase) over study period, corresponding a 147% increase per capita PTx rate. proportion performed very high-volume hospitals increased 6.4% 20.5% (P < 0.001). overall declined 8.7% 3.8% inversely related hospital (very high volume, 3.9% vs low 5.2%, P 0.05). Reoperation was 363 (2.1%). 0.91% 2.73% 0.01). nonlinearly as described equation % = 100/(total volume). CONCLUSIONS Surgery has grown safer more common time. High-volume centers have lower