Patientenzufriedenheit nach Reoperation bei primaerem Hyperparathyreoidismus: Perioperative Daten und Nachuntersuchungsergebnisse

Background: Reoperations for persistent or recurrent primary hyperparathyroidism (pHPT) carry higher morbidity than primary surgery. The observation that postoperative normocalcaemia does not necessarily result in patient satisfaction lead to this study. The question is, if despite the higher morbidity, reoperation improves quality of life. The correlation of laboratory results and and patients’ symptoms is analysed. The aim is to predict which patients will benefit most from reoperation. Methods: This prospective study analyses follow up and perioperative data of 50 patients (32 female, 18 male), reoperated between March 1987 and August 1997 for persistent or recurrent pHPT. At a median of 56 months postoperatively, a planned follow up was carried out. This included physical examination, laboratory investigations and evaluation of the patients’ quality of life as well as pHPT connected symptoms using a modified SF-36 questionnaire, an accepted health status assessment tool. 43 of the 50 patients included in the study, were available for assessment of quality of life, resulting in a follow up rate of 86%. 32 (64%) of these were able to attend for full follow up including laboratory investigations. The other 11 patients were interviewed via telephone. Results: In 88% (44 of 50 patients) of reoperations the pHPT was treated successfully, with normalisation of serum calcium. This was achieved by one reoperation in 84% of the cured patients. In 60% (30 patients) the operation was accomplished via neck incision alone. 7 solitary adenomas were found in normal anatomical position (14%). 8 patients (17%) suffered with true recurrent pHPT. 16 of the reoperations (32%) required sternotomy. Recurrent laryngeal nerve palsy was confirmed in 3 (6%) of the reoperations. 90.7% of patients were satisfied with the reoperation or stated they would, in retrospect, choose to be reoperated on again. 4 patients were dissatisfied and did not experience any benefit from reoperation. All dissatisfied patients had lower SF-36 scores for symptom improvement in all health domains than the satisfied patients. By far more satisfied than dissatisfied patients reported postoperatively they were symptom free. Amongst the dissatisfied patients “mental effects” were most commonly reported and “symptoms of weakness” were least improved. Discussion: There is a discrepancy between successful reoperation and postoperative patient satisfaction, as 75% of dissatisfied patients were cured by a single reoperation. The higher morbidity from sternotomy, recurrent laryngeal nerve palsy and persistent hypercalcaemia were contributing factors, though the main cause for reported dissatisfaction was lack of alleviation of pHPT related symptoms. Conclusions: Acceptance of reoperation primarily depends on alleviation of pHPT associated symptoms. Patients with severe preoperative symptoms benefit most from reoperation and sternotomy should be reserved for them. To optimise results patients should be treated from early on at specialised expert centres.