World Journal of Endocrine Surgery

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VOLUME 9 , ISSUE 3 ( September-December, 2017 ) > List of Articles

ORIGINAL ARTICLE

Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy

Alexandra Gorelik, Jake Osborne, Alexander Papachristos, Anita Skandarajah, Daniel Hng, Julie Miller

Citation Information : Gorelik A, Osborne J, Papachristos A, Skandarajah A, Hng D, Miller J. Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy. World J Endoc Surg 2017; 9 (3):88-93.

DOI: 10.5005/jp-journals-10002-1218

License: CC BY 3.0

Published Online: 00-12-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Hypocalcemia is a common complication of thyroidectomy. We aimed to assess compliance with a targeted calcium and calcitriol supplementation protocol and hypothesized that it would allow safe early discharge without an increase in readmissions.

Materials and methods

In 2009, we instituted a targeted early postoperative calcium and calcitriol supplementation protocol based on postoperative parathyroid hormone (PTH). We retrospectively reviewed all patients who had a total or completion thyroidectomy over a 4-year period prior to protocol implementation (group I: 2005—2008) and over a 5-year period after protocol implementation (group II: 2010—2014), as well as all patients operated on in the private setting with the senior author over a 1-year period (group III: 2013). Endpoints for analysis were clinically significant hypocalcemia, protocol compliance, hospital length of stay (LOS), and readmission for hypocalcemia.

Results

Compliance with the protocol was high; however, the accuracy of supplementation prescription was significantly lower in group II than in group III (p < 0.0001). Mean corrected calcium on postoperative day 1 was significantly higher in groups II (2.29 mmol/L) and III (2.27 mmol/L) compared with group I (2.15 mmol/L; p < 0.0001). Forty (30.5%) patients had clinically significant hypocalcemia in group I, compared with 21 (10.8%) in group II, and 2 (3.3%) in group III (p < 0.0001). The LOS was significantly decreased after protocol introduction (p < 0.0001).

Conclusion

Selective prophylactic calcium supplementation reduces LOS after total thyroidectomy.

Clinical significance

Introducing a new management protocol in the public hospital system poses challenges with compliance; however, it was successful in lowering rates of symptomatic hypocalcemia and LOS without an increase in the readmission rate.

How to cite this article

Osborne J, Papachristos A, Skandarajah A, Gorelik A, Hng D, Miller J. Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy. World J Endoc Surg 2017;9(3):88-93.


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