Parathyroid hormone-driven algorithms after thyroid surgery: Not one-size-fits-all.

Autor: Samargandy S; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada., Wadie J; School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland., Msallak H; Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Chiodo A; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada., El Masri W; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada., Hubbard B; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada., Enepekides D; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Higgins K; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Assal A; Division of Endocrinology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Fine R; Division of Endocrinology, Department of Medicine, Michael Garron Hospital, Toronto, Ontario, Canada., Fung R; Division of Endocrinology, Department of Medicine, Michael Garron Hospital, Toronto, Ontario, Canada., Nicholas E; Division of Endocrinology, Department of Medicine, Michael Garron Hospital, Toronto, Ontario, Canada., Beadle V; Department of Nursing, Michael Garron Hospital, Toronto, Ontario, Canada., Eskander A; Department of Otolaryngology - Head and Neck Surgery, Michael Garron Hospital, Toronto, Ontario, Canada.; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Head & neck [Head Neck] 2023 Mar; Vol. 45 (3), pp. 595-603. Date of Electronic Publication: 2022 Dec 26.
DOI: 10.1002/hed.27272
Abstrakt: Background: Underreported variation in parathyroid hormone (PTH) assays exists. Using quality improvement methods, we aimed to develop an institution-specific PTH-based protocol to predict hypocalcemia after thyroidectomy.
Methods: We retrospectively reviewed patients who underwent total/completion thyroidectomy. A receiver operating curve (ROC) determined postoperative PTH cut-offs predictive of hypocalcemia. The stakeholders developed PTH-driven calcium management guidelines. Post-implementation outcomes were prospectively measured.
Results: Pre-implementation, 95 patients were assessed. PTH ≤1.5 pmol/L (14.1 pg/ml) predicted hypocalcemia (96%sensitivity), and ≥2.8 pmol/L (26.4 pg/ml) predicted normocalcemia (99%specificity) (area under curve = 0.97, SEM = 0.018). PTH on the day of and morning after surgery were identically predictive. Post-implementation, 64 patients were assessed. Hypocalcemia occurred with PTH >2.8 pmol/L in 2 cases (3.1%). Calcium over-prescribing decreased from 13.7% to 3.1% (p = 0.06). Length of stay (LOS) > 2 nights decreased from 13% to 3.1% (p = 0.05).
Conclusion: A PTH-driven calcium management protocol post-thyroidectomy effectively reduces unnecessary calcium replacement and LOS. Given the variability in PTH assays, each institution may need to use individual cut-offs.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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