Optimizing Intraoperative Parathyroid Hormone Testing Protocols to Improve Efficiency and Outcomes in Parathyroid Surgery

Monday, October 13, 2025

3:06 PM - 3:12 PM EDT

Location: 109-110

Disclosure(s):

Hani Samarah, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Bryan A. Renslo, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Elizabeth E. Cottrill, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Intraoperative parathyroid hormone (iPTH) testing provides real-time feedback during parathyroidectomy, leveraging the hormone’s short half-life (1–3 minutes). However, processing delays can extend surgery, anesthesia, and operating room (OR) times. Anecdotal evidence suggests variability in iPTH processing times across surgical locations within the same institution. Identifying these delays is crucial for improving outcomes.

Methods: A retrospective review of 119 parathyroidectomy cases compared iPTH processing times at three surgical sites: L1 (large urban tertiary care center), L2 (urban outpatient surgical center), and L3 (small community-based tertiary care center). Cases included 60 patients at L1, 20 at L2, and 39 at L3, with comparable demographics (BMI, age). Timing variables included draw-to-result and lab-receipt-to-result times. Statistical analyses used Kruskal-Wallis tests with Dunn’s post-hoc comparisons (p < 0.05).

Results: Incision-to-extubation times were longer at L1 versus L2 (p = 0.016) and L3 (p = 0.005), with no difference between L2 and L3 (p = 1.000). Total operative times were also longer at L1 compared to L2 (p = 0.009) and L3 (p = 0.00015). Draw-to-result times were significantly longer at L1 (40.1 minutes) versus L3 (37.1 minutes; p = 0.008) but not L2 (28.2 minutes; p = 1.000). L2 had shorter draw-to-result times than L3 (p = 0.009). Lab-receipt-to-result times showed no significant differences (p = 0.614). Most cases involved unilateral exploration (L1: 37, L2: 17, L3: 29), with fewer bilateral explorations (L1: 22, L2: 2, L3: 9).

Conclusions: Significant iPTH processing delays at L1 contributed to longer operative times compared to L2 and L3. Delays occurred outside the lab, as lab-receipt-to-result times did not differ significantly, likely due to OR transport, specimen handling, or time-of-day variability. Root cause analysis and workflow evaluations are underway to standardize protocols, reduce delays, and improve efficiency and safety.

Presenting Author(s)

Hani Samarah, BS

Medical Student
Florida International University (Wertheim) - Medical College
Little Rock, AR, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

BR

Bryan A. Renslo, MD

Resident
Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Andrew T. Neeson, B.S.

Medical Student
Thomas Jefferson University
Chadds Ford, PA, United States

Disclosure information not submitted.
EF

Eric Fei, BA

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.
Harleen K. Sethi, DO

Fellow
Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure information not submitted.
KL

Kalena H. Liu, BS

Medical Student
Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

Elizabeth E. Cottrill, MD

Associate Professor of Otolaryngology Head & Neck Surgery
Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.