Surgical Subspecialty and Parathyroidectomy Outcomes: A National Analysis

Aims: Parathyroidectomy (PT) is commonly performed for hyperparathyroidism. We investigated the association between surgical subspecialty and adverse outcomes in patients undergoing PT. Materials and methods: This retrospective cohort analysis utilized the 2005–2018 National Surgery Quality Improvement Program (NSQIP) database. Current Procedural Terminology (CPT) codes were used to identify cases with a primary procedure of PT. Demographics, comorbidities, and complication incidences were compared between patients undergoing surgery by general surgeons or otolaryngologists using chi-square analyses. The independent effect of surgical subspecialty on adverse outcomes was analyzed using binary logistic regression. Results: 49,667 (86.7%) PT performed by general surgeons and 7,595 (13.3%) by otolaryngologists were identified from 2005 to 2018. Chi-square analysis indicated that general surgery patients had lower incidences of obesity (42.0% vs. 44.6%; p < 0.001) and higher incidences of diabetes mellitus (8.1% vs. 5.8%; p < 0.001). Demographic characteristics that significantly differed between cohorts included race (p < 0.001) and age (p < 0.001). Unadjusted analyses indicated that otolaryngologist-performed PT had lower incidences of unplanned reoperation (0.9% vs. 1.1%; p = 0.048) and unplanned readmission (2.9% vs. 3.6%; p = 0.009). After adjusting for confounders, logistic regression analyses indicated that otolaryngologist-performed PT had increased odds of prolonged operation time (OR 1.605; 95% CI 1.475–1.746; p < 0.001). Significant differences in mortality, medical complications, and surgical complications were not found. Conclusion: Surgical subspecialty is associated with PT operative time but is not associated with perioperative complications.