Invited Critique |

The Bayes Theorem Wins:  Comment on “Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery”

Quan-Yang Duh, MD
Arch Surg. 2011;146(12):1403. doi:10.1001/archsurg.2011.1001.
Text Size: A A A
Published online


Endocrine surgeons are known to be friendly, humble, and thoughtful intellectuals rather than chestthumpers. The main socially acceptable mode of competition among endocrine surgeons is their excellence in surgical outcome. One measure of endocrine surgeons' prowess is their parathyroidectomy success rate. For primary operations, the success rate is expected to be 96% to 99%. Even for reoperations, the success rate is expected to be 90% to 95%. Success rate is a simple fraction with a numerator and a denominator. As surgeons, we try to improve the percentage by having more accurate diagnosis and localization studies (LSs) and better knowledge of anatomy and embryology. Usually, we concentrate on improving the outcome of individual patients (the numerator). Shin et al1 remind us that the denominator is just as important. They analyzed a large series of reoperative parathyroidectomy from Cleveland Clinic, a center of excellence for complex parathyroid surgery. They show that the expected success rate depends on how and when you measure it. For a patient already scheduled for a reoperative parathyroidectomy, the expected success rate is 96%, but for a patient who has an indication for reoperative parathyroidectomy who has not yet undergone LSs, the expected success rate is only 83% because those with negative LSs usually could not undergo parathyroidectomy. Similarly, the PPVs of their LSs depended on whether nonoperated patients were included in the calculation and whether clinical scenarios (CSs) were considered.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Thymoma and Parathyroid Adenoma: False-Positive Imaging and Intriguing Laboratory Test Results. JAMA Otolaryngol Head Neck Surg Published online Feb 20, 2014.;