A faster parathyroidectomy: Techniques to shorten non-surgical operating room time

Objective: To assess the capacity of different techniques to reduce non-operative times during parathyroid surgery. The impact of monitored anesthesia care (MAC) instead of general anesthesia, and the pre-operative placement of a second peripheral intravenous catheter (PINT) were analyzed. Methods: A retrospective case series at an academic medical center was performed to study patients undergoing parathyroidectomy by a single surgeon between November 2013 and October 2016. Three operating room (OR) time measurements were compared: pre-incision time, post-closure time, and total OR time. Results: Surgeries performed under MAC (n = 21) had statistically shorter pre-incision (33.2 min vs. 39.7 min, p<.001), post-closure (10.1 min vs. 16.2 min, p=.002), and total operative times (113.0 min vs. 151.5 min, p<.001) compared to those in which general anesthesia (n = 169) was used. Of the 169 patients who underwent general anesthesia, 25 had a second PINT placed preoperatively and 144 had only a single PIV. All 3 time periods were statistically shorter in patients who had a second PINT versus those who had only a single Ply (pre-incision 32.2 min vs. 41.0 min, p<.001; post-closure 12.2 min vs. 16.9 min, p<.001; total 117.9 min vs. 157.4 min, p<.001). Conclusions: In patients undergoing parathyroid surgery in which ioPTH levels will be used, the placement of a second PINT in the pre-operative holding area and performance of surgery under MAC can significantly shorten non-operative and total OR time.