Trends in parathyroidectomy
Reviewed by Thomas Jacques

The authors retrospectively analysed Hospital Episode Statistics data for parathyroidectomy between 2000 and 2010. Overall, parathyroidectomy rates nearly doubled from 3.3/100,000 population in 2000 to 5.8/100,000 in 2010, with particularly significant increases in elderly patients. The authors attribute this rise to the development of standardised endocrinological guidelines indicating surgery in asymptomatic hypercalcaemia, and an increasing life expectancy. Improvements in pre-operative localisation have also led to an increase in minimally-invasive parathyroidectomy, allowing shorter anaesthetic times, or even surgery under local anaesthesia. The data may not apply to surgery for secondary or tertiary hyperparathyroidism (HPT), but the authors point out that the most recent British Association of Endocrine and Thyroid Surgeons (BAETS) audit shows that around 90% of surgery is performed for primary HPT. The authors’ conclusions do rely on inference, but the reasoning is very plausible and an interesting insight. They reflect that the changes mirror a more general trend, whereby improvements in diagnostic and surgical technology tend to expand the indications for surgical procedures.

A decade of change in the uptake of parathyroidectomy in England and Wales.
Evans LM, Owens D, Scott-Coombes DM, Stechman MJ.
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
2014;96(5):339-42.