Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone
Autor: | Joshua, Park, Ethan, Frank, Alfred, Simental, Sara, Yang, Christopher, Vuong, Steve, Lee, Pedro Andrade, Filho |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male Postoperative Care Time Factors Dose-Response Relationship Drug Hypocalcemia Disease Management Middle Aged Risk Assessment California Drug Administration Schedule Cohort Studies Hospitals University Treatment Outcome Parathyroid Hormone Thyroidectomy Humans Female Aged Follow-Up Studies Retrospective Studies |
Zdroj: | The American surgeon. 82(10) |
ISSN: | 1555-9823 |
Popis: | After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation. |
Databáze: | OpenAIRE |
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