INTRODUCTION: Assess temporal utilization trends, identify predictors, and compare early postoperative outcomes of parathyroid autotransplantation (PTAT) in pediatric total thyroidectomy (TT) patients. METHODS: Patients <
18 y undergoing TT between 2015 and 2021 were obtained from the National Surgical Quality Improvement Program-Pediatric database. Characteristics and outcomes were described and stratified by extent of node dissection. Temporal trends and predictors of PTAT were evaluated by multivariable logistic regression. Propensity score matching was used to compare PTAT clinical outcomes. RESULTS: Among 2444 children (median age 14.9 y), 78% had thyroidectomy alone, 17% had thyroidectomy with central lymph node dissection, and 5% had thyroidectomy with modified radical neck dissection. Of the 150 patients who underwent PTAT, 62% were transplanted in the neck and 38% in the forearm. Overall, 0.6% had nerve injury/repair, 14% had prolonged postoperative hospitalization, and 0.9% was readmitted for hypocalcemia. Utilization of PTAT decreased over time. Predictors included adult general surgery/otolaryngology subspecialty (odds ratio 2.0, 95% confidence interval 1.3-3.2, P = 0.005) and extent of node dissection (odds ratio 3.2, 95% confidence interval 1.9-5.5, P <
0.0001). No significant differences in prolonged hospitalization (18% versus 13%, P = 0.10) or readmission for hypocalcemia (2.7% versus 1.1%, P = 0.23) were observed on propensity score matching. CONCLUSIONS: PTAT in pediatric TT is more commonly performed by adult subspecialty surgeons and in the setting of more extensive node dissections. PTAT utilization decreased over time. No significant differences in early postoperative outcomes were observed between cohorts. Further studies are needed to guide optimal parathyroid preservation strategies in children.