Identification of Parathyroid Glands Through Near-Infrared Autofluorescence During Thyroid Surgery: Retrospective Analysis of the Impact on Post-Operative Hypocalcemia Rate Reduction and Potential Improvement of Healthcare Expenditure

Background and objectives: The identification and preservation of the parathyroid glands (PGs) are of paramount importance in thyroid surgery. Permanent hypoparathyroidism represents a significant post-operative complication that may result from the surgeon’s failure to accurately identify the PGs or their associated blood supply. Post-operative hypocalcemia (POH) represents the most common surgical complication following thyroid surgery and is the primary factor influencing the post-operative course, causing the requirement of frequent electrolyte monitoring and of supportive therapies, precluding the possibility of early discharge, and resulting also in significant healthcare costs. Near-infrared autofluorescence (NIRAF) employs the intrinsic capacity of PGs to emit fluorescent light when exposed to light within the NIR spectrum. In the context of thyroid surgery, NIRAF represents a safe method with no documented risks to the patient. Materials and Methods: A retrospective analysis was conducted on 383 patients who underwent thyroid surgery at our Institution, either with (n = 27) or without (n = 356) intraoperative NIRAF, focusing on its efficacy in reducing the incidence of POH. Conclusions: Our results suggest that the systematic integration of NIRAF within non-high-capacity centres for cervical surgery, owing to its usefulness in identifying PGs intraoperatively, may strongly contribute to a reduction in the incidence of POH (45.8% without vs. 18.5% with NIRAF; p = 0.0078). This, in turn, has the potential to contribute to a decrease in overall healthcare expenditure.