OP34 – Risk factors for postoperative hypocalcemia. A retrospective study in a Community Hospital of La Plata, Argentina

     

    Zund, Santiago1, Stoppini Gallagher, Maximiliano1, Pérez Irigoyen, Claudio2
    1 Division of Head & Neck Surgery, Hospital Español, La Plata, Buenos Aires, Argentina
    2 Department of General Surgery, Hospital Español, La Plata, Buenos Aires, Argentina

     

    Background/ Purpose: Hypocalcemia is the most common complication after total thyroidectomy (TT). Nevertheless, some preoperative predictive factors of this event are still unclear. The aim of this study was to evaluate the role of risk factors for hypocalcemia after TT, and secondary the utility of intact parathyroid hormone (PTHi) for early discharge.

    Methods: Retrospective study of patients that underwent TT between 2008 and 2016. Same surgeon, same team, same Institution. Hypocalcemia was defined as a calcium <8 mg/dl or ionic calcium <4 mg/dl after TT. Permanent hypocalcemia if these values were present or requiring calcium/vitamin D supplementation for more than a year. PTHi was checked postoperative. Statistical analysis: SPSS Windows 19.0.

    Results: A total of 281 patients underwent TT. Histology revealed benign and malignant disease in 64.5% and 35.5% of cases, respectively. Central-compartment neck dissection (CCND) was performed in 33 subjects (11.7%), with 14 (42%) therapeutic dissections, and 19 (48%), prophylactic lymphadenectomies. Laboratory asymptomatic hypocalcemia was observed in 46 (16.4%) patients; symptomatic hypocalcemia occurred in 34 (12.1%). Transient hypocalcemia (laboratory plus symptomatic) was observed in 80 (28.4%) patients, while permanent hypocalcemia occurred only in three patients (1%) that underwent TT with CCND for thyroid cancer. Parathyroid gland reimplantation was performed in 35.2% (99) of the cases. No parathyroid glands were found on the specimens. On univariate analysis, malignant pathology (p< 0.001), CCND (p< 0.05), female gender (p< 0.001), PTH?10 pg/ml (p were factors that significantly increased the risk of developing symptomatic hypocalcemia. Regarding asymptomatic hypocalcemia,……, were risk factors.

    Discussion and Conclusion: Cancer pathology, CCND and PTHi?10 pg/ml were predictive factors of symptomatic and laboratory hypocalcemia. Postoperative PTHi levels >20 pg/ml were safe for early discharge. The use of this cut-off might avoid unnecessary extensions of hospitalization.

     

    References:

    1. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high- volume surgeons. Ann Surg Oncol 2014;21:3844-3852
      Lee YS, Chang H-S, Chung WY, Nam K-H, Park CS. Relationship between onset of hypocalcemic symptoms and the recovery time from transient hypocalcemia after total thyroidectomy. Head Neck 2014;36:1732-1736
    2. Bhattacharyya N, Fried M. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128:389-392
    3. Chislholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 2009;119:1135-1139
    4. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP.  Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. BJS 2014;101;307-320
    5. Docimo G, Ruggiero R, Casalino G, Del Genio G, Docimo L, et al. Risk factors for postoperative hypocalcemia. Updates Surg. 2017 Apr 25. doi: 10.1007/s13304-017-0452-x. [Epub ahead of print]
    6. Inversini D, Rausei S, Ferrari CC, Frattini F, Anuwong A. Early intact PTH (iPTH) is an early predictor of postoperative hypocalcemia for a safer and earlier hospital discharge: an analysis on 260 total thyroidectomies. Gland Surg 2016;5(5):522-528

 

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