LAUSR

BACKGROUND Intraoperative parathyroid hormone (IOPTH) testing facilitates focused parathyroidectomy to establish biochemical cure but may be time-consuming. A dedicated immunoassay machine was relocated to the operating room for IOPTH. These data seek to determine association of operating room-based IOPTH with operative time, lab turnaround time (TAT), and cost. METHODS Patients who underwent parathyroidectomy from June 2017 to February 2020, were reviewed. Clinical and demographic data, operative time, and TAT were collected. Patients were compared by operation dates pre- or post-machine acquisition. A cost model was created to evaluate cost of care before and after OR-based testing. RESULTS 285 patients were included. Post-machine, median operative time decreased from 69 minutes (IQR 60-84) to 57 minutes (IQR 50-84.5), p=0.03. Additionally, median TAT for IOPTH values (Pre-op, 0, 5, 10, and 15 minutes) decreased post-machine: Time Pre-op: 29 minutes (IQR 23-40) vs 18 minutes (IQR 17-23.5), p<0.001; Time 0: 33 minutes (IQR 27-39) vs 18.5 minutes (17.5-21), p<0.001; Time 5 minutes: 31 minutes (IQR 26-36) vs 20 minutes (IQR 18.5-21), p<0.001; Time 10 minutes: 32 minutes (IQR 27-39) versus vs 20 minutes (IQR 18.5-22.5), p<0.001; Time 15 minutes: 30 minutes (IQR 26-36) vs 19 minutes (IQR 17-21), p<0.001. Total costs pre- and post-machine were $4,442 and $4,111, respectively. With $331 cost-reduction/operation and 127 operations/year, the IOPTH machine pays for itself in 3 years, or 378 surgeries, and saves $168,589 in the machine's remaining 4-year lifespan. CONCLUSION Operating room-based parathyroid hormone testing results in improved operating productivity by decreasing result TAT and operative time and reduces cost.