title: Hypocalcemia after total laryngectomy: incidence and risk factors.
abstract: OBJECTIVE
  Hypocalcemia is common in the initial period after total laryngectomy. The purpose of the present study was to study the incidence of and risk factors for postlaryngectomy hypocalcemia at our institution.
  
  
  METHODS
  Retrospective review of 65 consecutive total laryngectomies.
  
  
  METHODS
  Clinical data and calcium levels for the first postoperative week were collected. Biochemical hypocalcemia was defined as any corrected calcium level of < 2.0 mmol/l in the first postoperative week. Severe hypocalcemia was defined as a calcium of < 1.8 mmol/l, or symptoms of hypocalcemia. Risk factors for hypocalcemia were studied.
  
  
  RESULTS
  Five cases were excluded due to concomitant abdominal surgery (3), preoperative hypocalcemia (1), and no postoperative calcium levels (1). A total of 43% of patients had postoperative biochemical hypocalcemia. On univariate analysis, bilateral neck dissection was significant for hypocalcemia (P = 0.02), with pT4 classification having borderline significance (P = 0.07). On multivariate analysis, bilateral neck dissection (P = 0.02) and salvage surgery were significant (P = 0.03), with pT4 stage again having borderline significance (P = 0.05). Extent of thyroidectomy, extent of pharyngectomy, and preoperative tracheostomy were not significant. Fifteen patients (25%) had severe hypocalcemia. There were no significant risk factors for severe hypocalcemia identified.
  
  
  CONCLUSIONS
  Hypocalcemia is common after total laryngectomy, particularly in the postradiotherapy setting and in patients undergoing bilateral neck dissection. Preservation of one thyroid lobe does not appear to significantly reduce the risk.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland.
authors.forename: Naveed
authors.initials: N
authors.lastname: Basheeth
authors.forename: Eadaoin
authors.initials: E
authors.lastname: O'Cathain
authors.forename: Gerard
authors.initials: G
authors.lastname: O'Leary
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Laryngectomy; complications; hypocalcemia; hypoparathyroidism; radiotherapy