Impact of outcomes data on the management of postoperative hypocalcemia in head and neck endocrine surgery patients.

Autor: Fitzpatrick TH 4th; Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27104, United States of America. Electronic address: tfitzpat@wakehealth.edu., Magister MJ; Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address: mmagiste@wakehealth.edu., Browne JD; Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address: jdbrowne@wakehealth.edu., Waltonen JD; Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address: jwaltone@wakehealth.edu., Henderson BB; Charleston Thyroid Center, United States of America. Electronic address: drhenderson@charlestonthyroid.com., Patwa HS; Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address: hpatwa@wakehealth.edu., Sullivan CA; Wake Forest Baptist Medical Center, Department of Otolaryngology-Head and Neck Surgery, United States of America. Electronic address: csulliva@wakehealth.edu.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2020 Jul - Aug; Vol. 41 (4), pp. 102477. Date of Electronic Publication: 2020 Apr 06.
DOI: 10.1016/j.amjoto.2020.102477
Abstrakt: Postoperative hypocalcemia is a well-described outcome following thyroid and parathyroid surgery with symptoms ranging from clinically insignificant laboratory findings to tetany and seizures. The aims of this study were 1. To identify the characteristics and management patterns of postoperative hypocalcemia in head and neck endocrine surgery patients and 2. To compare outcomes between patients treated with empiric calcium and patients treated using a biochemically driven calcium replacement algorithm. Clinical electronic medical record (EMR) data was collected from patients who had undergone total thyroidectomy, completion thyroidectomy, and/or parathyroidectomy at Wake Forest Baptist Medical Center (WFBMC), a tertiary referral and academic institution. Between July 1, 2016, and June 30, 2017, 298 adult patients underwent surgery by a WFBMC Head & Neck (H&N) endocrine surgeon. Objective calcium and parathyroid hormone levels, postoperative supplementation with calcium and Vitamin D, 30-day physician access line (PAL) phone call utilization, emergency department (ED) encounters, and readmission rates were queried. The overall rate of hypocalcemia was 17.4%. No statistically significant difference in PAL utilization, ED visits, or readmissions was found between the empiric supplementation group and those whose supplementation was biochemically directed (PAL 5.0% vs. 5.0% [p = 0.983], ED visit 3.3% vs. 2.5% [p = 0.744], Readmission 1.7% vs. 0% [p = 0.276]). The overall postoperative rates of hypocalcemia and hypoparathyroidism following H&N endocrine surgery were consistent with the reported literature. Neither method of calcium supplementation was superior in reducing PAL utilization, ED encounters, or readmission.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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