Surgical Outcomes and Operative Time in Parathyroidectomy With and Without the Miami Protocol: A Comparative Analysis

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Introduction: Parathyroidectomy is the definitive treatment for primary hyperparathyroidism (PHPT).While intraoperative parathyroid hormone (IOPTH) monitoring (the Miami Protocol) is widely used to guide surgical success and enable minimally invasive approaches, its impact on operative metrics remains debated.This study compares surgical outcomes and operative times in parathyroidectomy with and without the Miami Protocol at two tertiary care hospitals within a private academic healthcare system.Materials and methods: This retrospective, comparative study analyzed electronic medical records of 51 adult patients who underwent parathyroidectomy for PHPT at TecSalud hospitals between January 2021 and June 2025.Patients were stratified into two groups: Group 1 (Miami Protocol with IOPTH measurement, n = 11) and Group 2 (No Miami Protocol, n = 40).Evaluated variables included demographic characteristics, baseline comorbidities, presurgical localization studies, histopathological findings, early biochemical normalization rates, postoperative complications, hospital stay, and total operative time.Results: Baseline characteristics and comorbidity distributions were similar between groups.Early biochemical normalization was observed in 49/50 (98.0%) of evaluable patients: 11/11 (100%) in Group 1 and 38/39 (97.4%) in Group 2 (p = 1.000).In-hospital complications and reinterventions occurred in 1/51 (2.0%) and 2/51 (3.9%) of patients, respectively, with no statistically significant differences between groups.Mean length of hospital stay was 1.2 ± 0.77 days.Operative time was longer in the Miami Protocol group than in the group without IOPTH monitoring (127.8 ± 58.5 minutes vs. 76.2 ± 45.6 minutes; p = 0.004).Exploratory analyses also found longer operative times in patients with hyperplastic pathology and bilateral cervical exploration.Conclusions: IOPTH use was associated with a longer observed operative time.Early biochemical normalization was frequent, and in-hospital complications and reinterventions were uncommon.However, the retrospective design, small and unequal groups, surgeon-level confounding, and limited follow-up preclude conclusions regarding causality or equivalence.Further prospective studies are needed to evaluate criteria for selective IOPTH use.