Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy.
OBJECTIVE
Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post-thyroidectomy without compromising safety.


METHODS
This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6-hour critical level of PTH > or = 28 ng/L and simultaneous corrected calcium > or = 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1-hour PTH levels < or = 8 ng/L were prophylactically treated with calcium and vitamin D supplementation.


RESULTS
This study demonstrates lower rates of transient hypocalcemia from 28% to 9% (OR = 4.13, P = 0.016), a 10-hour reduction in mean hospital stay, and fewer blood tests (23 vs 15) for patients undergoing total thyroidectomy since the implementation of the new protocol. Furthermore, the experimental protocol resulted in an average cost savings of 766 Canadian dollars per patient.


CONCLUSIONS
The new algorithm resulting from PTH and corrected calcium monitoring at 1 and 6 hours post-thyroidectomy has led to significant cost savings for our institution. It has also translated into greater patient satisfaction as a result of fewer blood tests, a lower incidence of transient hypocalcemia, and significantly shorter hospital stays.
Payne
Richard J
RJ
Department of Otolaryngology--Head and Neck Surgery, Jewish General Hospital, McGill University, Canada. rkpayne@sympatico.ca
Tewfik
Marc A
MA
Hier
Michael P
MP
Tamilia
Michael
M
Mac Namara
Elizabeth
E
Young
Jonathan
J
Black
Martin J
MJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D002118:Calcium / Q000097:blood*; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000191:economics / Q000209:etiology; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011183:Postoperative Complications; D011446:Prospective Studies; D013965:Thyroidectomy / Q000191:economics*; D013997:Time Factors
D010281:Parathyroid Hormone; D002118:Calcium