Parathyroid gland surgery is more successful and less expensive at academic medical centers with specialized endocrine facilities and experienced surgeons than at hospitals where fewer of the operations are done, a Johns Hopkins study suggests.
"Our findings show that improved outcomes and lower costs depend on an experienced surgeon," says Robert Udelsman, M.D., the study's senior author and director of endocrine and oncologic surgery at Hopkins.
The results, published in the December issue of Surgery, also underscore the role of academic medical centers in delivering high-quality, low-cost treatment as the nation moves more patients into health care systems that emphasize cost controls, Udelsman says.
Researchers compared costs and outcomes of 901 patients who underwent surgery for hyperparathyroidism at 52 Maryland hospitals from 1990 to 1994 with 169 patients who underwent the same procedure at Hopkins during that period.
Results show that 47 of the 52 hospitals performed fewer than 10 parathyroidectomies -- or removal of the parathyroid glands -- per year, but that these lower-volume hospitals accounted for 80 percent of in-hospital deaths. There were no deaths at Hopkins or the other medical centers where more than 20 of the procedures were done per year.
Length of stay decreased from seven days to three days at lower-volume hospitals, but decreased even further at Hopkins to about one day, the results show. Hopkins' cure rate was 97 percent during this period as its caseload increased from 8 percent to 21 percent. Cure rates were unavailable for lower-volume hospitals.
"But one common strategy of third-party payers, including insurance companies and health maintenance organizations, to try to minimize costs has been to continue referring some parathyroidectomy patients to contracted physicians at community hospitals rather than academic medical centers," says Udelsman.
This strategy often backfires, resulting in twice the costs and more complications than at high-volume endocrine surgery centers, according to the Hopkins study and studies elsewhere. Similar research at Hopkins and other medical centers also shows higher success rates and lower costs at high-volume centers for other surgical procedures.
About 100,000 new cases of hyperparathyroidism are diagnosed each year in the United States. Surgical removal of the parathyroid glands is the only cure.
The study's other authors were Herbert Chen, M.D.; Martha A. Zeiger, M.D.; and Toby Gordon, Sc.D.
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