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- Title
Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone.
- Authors
PARK, JOSHUA; FRANK, ETHAN; SIMENTAL JR., ALFRED; SARA YANG; VUONG, CHRISTOPHER; LEE, STEVE; FILHO, PEDRO ANDRADE; Simental, Alfred Jr; Yang, Sara
- Abstract
After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.
- Subjects
CALIFORNIA; THYROIDECTOMY; PARATHYROID hormone; SURGICAL complications; HYPOCALCEMIA; LENGTH of stay in hospitals; MEDICAL protocols; DISEASE risk factors; ACADEMIC medical centers; DRUG administration; DOSE-effect relationship in pharmacology; LONGITUDINAL method; POSTOPERATIVE care; RISK assessment; TIME; DISEASE management; TREATMENT effectiveness; RETROSPECTIVE studies; PREVENTION
- Publication
American Surgeon, 2016, Vol 82, Issue 10, p881
- ISSN
0003-1348
- Publication type
journal article
- DOI
10.1177/000313481608201004