Restoring Point-of-Care Testing during Parathyroidectomy with a Newer Parathyroid Hormone Assay

Abstract

Objective. Intraoperative parathyroid hormone (IOPTH) monitoring has emerged as a useful adjunct in parathyroidectomy. Originally performed within the operating room, removal of the Nichols assay from the market forced many surgeons to rely on testing done in central laboratories, reducing convenience and prolonging operative times. The authors hypothesized that PTH assessment with a newer point-of-care (POC) assay would reduce results reporting time compared with central-laboratory PTH assays.

Study Design. Cross-sectional study with planned data collection.

Setting. Academic medical center.

Subjects and Methods. Patients underwent parathyroidectomy for primary or recurrent hyperparathyroidism. Intraoperative monitoring of serum PTH levels was used to confirm biochemical cure following adenoma excision. Samples were run in duplicate using both a POC PTH assay (Future Diagnostics) located within the operating room and a laboratory-based assay (Turbo PTH). Samples were taken at incision and at 5-, 10-, and 15-minute intervals following removal of suspected parathyroid adenomas. Results reporting time was recorded and compared by nonparametric Wilcoxon rank sum test.

Results. Sixty-six serum samples were assayed. There was excellent correlation between POC and central-laboratory IOPTH results (r = 0.880, P < .001). The POC IOPTH results were available faster than corresponding central-laboratory results, with a mean of 14.4 minutes compared with 30.7 minutes, respectively (P < .001). All patients (100%) demonstrated a biochemical cure by the end of the procedure.

Conclusion. Use of a rapid POC IOPTH assay results in a significant decrease in the amount of time for laboratory results to be communicated to the surgical team. This reduces operative times for parathyroidectomy and improves patient care.