Post-thyroidectomy hypocalcemia: impact on length of stay.
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Authors
Ahmed, Mohammed
Buch, Harit
Cullen, Ronald J
Gama, Rousseau
Liew, Leonard
Issue Date
2015-07-01
Journal
Type
Guideline
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Adult
Algorithms
Calcium
Critical pathways
Dietary supplements
Hypocalcaemia
Length of stay
Patient outcomes
Peer-reviewed article
Postoperative care
Thyroidectomy
Vitamin D
Retrospective study
Algorithms
Calcium
Critical pathways
Dietary supplements
Hypocalcaemia
Length of stay
Patient outcomes
Peer-reviewed article
Postoperative care
Thyroidectomy
Vitamin D
Retrospective study
Journal Title
Ear, Nose and Throat Journal
Volume
94
Issue
7
Begin page
276
End page
281
Abstract
Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.
Citation
Grainger J, Ahmed M, Gama R, Liew L, Buch H, Cullen RJ. Post-thyroidectomy hypocalcemia: Impact on length of stay. Ear Nose Throat J. 2015 Jul;94(7):276-81. doi: 10.1177/014556131509400711. PMID: 26214669.