title: Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy.
abstract: 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.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, Jewish General Hospital, McGill University, Canada. rkpayne@sympatico.ca
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Payne
authors.forename: Marc A
authors.initials: MA
authors.lastname: Tewfik
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hier
authors.forename: Michael
authors.initials: M
authors.lastname: Tamilia
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mac Namara
authors.forename: Jonathan
authors.initials: J
authors.lastname: Young
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Black
mesh_terms: 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
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium