Gastrointestinal surgery, malabsorptive conditions, and postoperative hypocalcemia after neck surgery.

Autor: Passman JE; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: Jesse.Passman@pennmedicine.upenn.edu., Ginzberg S; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: https://twitter.com/SaraGinzbergMD., Gasior JA; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: https://twitter.com/JuliaAGasior., Krumeich L; Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/LaurenNorell., Brensinger C; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Bader A; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: https://twitter.com/AmandaBader4l., Hwang J; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA., Kelz R; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Wachtel H; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Oct 28. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1016/j.surg.2024.08.057
Abstrakt: Background: Postoperative hypocalcemia is a common complication of thyroid and parathyroid surgery. Patients with prior gastric bypass face increased risk of postoperative hypocalcemia, but the impact of other malabsorptive conditions is not well understood. In this study, we evaluated the relationship between multiple medical and surgical malabsorptive states and hypocalcemia after thyroid and parathyroid surgery.
Methods: We performed a retrospective cohort study of patients who underwent total thyroidectomy and/or parathyroidectomy in Optum's deidentified Clinformatics Data Mart Database (2004-2022). Patients were categorized as having surgical (foregut/midgut: gastrectomy, intestinal bypass, enterectomy, enterostomy, pancreatectomy, or hindgut: colectomy/colostomy) or medical (Crohn or Celiac disease) malabsorptive conditions. The primary outcomes were early (<7 days) and late (7-365 days) postoperative hypocalcemia. Logistic regression was performed to determine the associations between malabsorptive conditions and outcomes.
Results: Of 25,400 patients (56.9% total thyroidectomy, 40.8% parathyroidectomy, and 2.4% both procedures), 4.0% had a pre-existing malabsorptive condition. Early postoperative hypocalcemia occurred in 8.8% of patients, and late hypocalcemia in 18.3%. Thyroidectomy was associated with a greater likelihood of hypocalcemia than parathyroidectomy (odds ratio: 1.22; P < .001). Pancreatectomy was associated with twice the adjusted odds of postoperative hypocalcemia (odds ratio: 2.27; P = .031) across both procedures. Patients with prior foregut/midgut surgery were at higher risk after total thyroidectomy (odds ratio: 1.65, P = .002). This association was significant in late (odds ratio: 1.82, P < .001) rather than early hypocalcemia (odds ratio: 1.33, P = .175). Hindgut surgery and medical malabsorption did not demonstrate such associations.
Conclusion: Prior foregut and midgut resections may predispose patients to postoperative hypocalcemia, particularly in patients undergoing total thyroidectomy.
Competing Interests: Conflict of Interest/Disclosure The authors have no related conflicts of interest to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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