title: Safety, efficacy, and cost savings of single parathyroid hormone measurement for risk stratification after total thyroidectomy.
abstract: The management of hypocalcemia (HC) after total thyroidectomy (TTx) is a challenge as TTx is transitioned into a same-day surgery. Measurement of parathyroid hormone (PTH) level after TTx may allow for prediction of postoperative HC and lead to shorter hospital stays. A prospective database was queried between January 2010 and June 2012 with 95 patients who had undergone TTx identified. Patient demographics; preoperative diagnosis; laboratory values and cost; complications; intravenous calcium supplementation; and length of stay (LOS) were analyzed. A PTH-based algorithm was retrospectively applied and theoretical cost savings were analyzed in terms of laboratory cost, LOS, and total cost. Ninety-five patients underwent TTx: 37 patients (38.9%) had cancer, whereas 27 (28.4%) had Graves' disease and the remaining 31 (32.6%) had a benign multinodular goiter. Postoperative PTH was recorded in 72 patients (74.4%); 46 (63.8%) had PTH greater than 10 pg/mL and 26 (36.9%) had PTH less than 10 pg/mL. Transient HC occurred in 10 patients (38.4%) with PTH less than 10 pg/mL (relative risk, 17.69; P = 0.0001). Patients with PTH less than 10 pg/mL incurred a 14.9 per cent higher hospital cost compared with those with PTH greater than 10 pg/mL. With retrospective implementation of the algorithm, there is a potential 46.4 per cent cost savings for the PTH less than 10 pg/mL group, 67.3 per cent savings for the PTH greater than 10 pg/mL group, and 46.7 per cent savings when taken altogether. Algorithmic risk stratification based on postoperative PTH less than 10 pg/mL serves as both a sensitive (100%) and specific (76.7%) predictor of postoperative HC. Such risk stratification may allow for same-day discharge in a number of patients, and even in patients requiring an overnight stay, result in cost savings as a result of a reduction in laboratory expenditures.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. mcculloughmeghan@gmail.com
authors.forename: Meghan
authors.initials: M
authors.lastname: McCullough
authors.forename: Collin
authors.initials: C
authors.lastname: Weber
authors.forename: Chris
authors.initials: C
authors.lastname: Leong
authors.forename: Jyotirmay
authors.initials: J
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D017046:Cost Savings / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D005260:Female; D005845:Georgia; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000191:economics; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013965:Thyroidectomy
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone