Risk factors for severe postoperative hypocalcaemia after operations for primary hyperparathyroidism.
OBJECTIVE
To identify risk factors for severe hypocalcaemia after surgery for primary hyperparathyroidism.


METHODS
Retrospective study followed by a prospective study.


METHODS
University hospital, Denmark.


METHODS
340 consecutive patients, operated on from 1991 to 1999, and 85 consecutive patients operated on in 2000.


METHODS
Predictive value of identified risk factors.


RESULTS
Incisional biopsy or excision of more than 2 parathyroid glands, thyroid operation together with parathyroidectomy, preoperative serum concentration of parathyroid hormone of more than 25 pmol/L, or a history of previous operations on the neck, were identified retrospectively as risk factors for severe postoperative hypocalcaemia. In the prospective study these factors showed a sensitivity of 100% (9/9), and a specificity of 25% (9/36). We found no risk of severe hypocalcaemia after parathyroidectomy in patients without these risk factors. The risk increased to 37% (7/19) if serum concentration of parathyroid hormone was more than 25 pmol/L, or if thyroidectomy was done together with parathyroidectomy.


CONCLUSIONS
Patients with no risk factors for severe hypocalcaemia can be discharged early from hospital. Special attention should be given to patients with one or more risk factors for severe hypocalcaemia.
Kald
Bengt Ahringberg
BA
Department of Endocrine Surgery, Rigshospitalet, Copenhagen, Denmark. bengt.ka@rh.dk
Mollerup
Charlotte L
CL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D006996:Hypocalcemia / Q000097:blood / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects
D010281:Parathyroid Hormone