title: Post-thyroidectomy hypocalcemia: Impact on length of stay.
abstract: Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.
authors.affiliation: Department of Paediatric ENT, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. joe.grainger@bch.nhs.uk.
authors.forename: Joe
authors.initials: J
authors.lastname: Grainger
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ahmed
authors.forename: Rousseau
authors.initials: R
authors.lastname: Gama
authors.forename: Leonard
authors.initials: L
authors.lastname: Liew
authors.forename: Harit
authors.initials: H
authors.lastname: Buch
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000465:Algorithms; D002118:Calcium / Q000627:therapeutic use; D019091:Critical Pathways; D019587:Dietary Supplements; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology* / Q000628:therapy*; D007902:Length of Stay; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D014807:Vitamin D; D002118:Calcium