Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study
Purpose Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge. Methods We present a prospective study including pat...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2015-10, Vol.400 (7), p.831-836 |
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| creator | Schlottmann, F. Arbulú, A. L. Campos Sadava, E. E. Mendez, P. Pereyra, L. Fernández Vila, J. M. Mezzadri, N. A. |
| description | Purpose
Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
Methods
We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium |
| doi_str_mv | 10.1007/s00423-015-1341-8 |
| format | Article |
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Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
Methods
We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.
Results
One hundred and six patients were included. Thirty-six (33.9 %) patients presented hypocalcemia. A 50 % decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73 %, respectively). No patients with a decrease <35 % developed hypocalcemia (100 % sensitivity), and all patients with a decrease >80 % had hypocalcemia (100 % specificity).
Conclusions
PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80 % drop in PTH levels can be safely discharged the day of the surgery.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-015-1341-8</identifier><identifier>PMID: 26362424</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Algorithms ; Cardiac Surgery ; Cohort Studies ; Female ; Follow-Up Studies ; General Surgery ; Humans ; Hypocalcemia - blood ; Hypocalcemia - epidemiology ; Hypocalcemia - etiology ; Incidence ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Monitoring, Physiologic ; Original Article ; Parathyroid Hormone - blood ; Patient Discharge ; Postoperative Period ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Thoracic Surgery ; Thyroidectomy - adverse effects ; Thyroidectomy - methods ; Time Factors ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgery ; Young Adult</subject><ispartof>Langenbeck's archives of surgery, 2015-10, Vol.400 (7), p.831-836</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-3d92eecdc44cd189e32f6224533de531ef710530205c116d179a74c31b6b4a0e3</citedby><cites>FETCH-LOGICAL-c414t-3d92eecdc44cd189e32f6224533de531ef710530205c116d179a74c31b6b4a0e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-015-1341-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-015-1341-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26362424$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schlottmann, F.</creatorcontrib><creatorcontrib>Arbulú, A. L. Campos</creatorcontrib><creatorcontrib>Sadava, E. E.</creatorcontrib><creatorcontrib>Mendez, P.</creatorcontrib><creatorcontrib>Pereyra, L.</creatorcontrib><creatorcontrib>Fernández Vila, J. M.</creatorcontrib><creatorcontrib>Mezzadri, N. A.</creatorcontrib><title>Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
Methods
We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.
Results
One hundred and six patients were included. Thirty-six (33.9 %) patients presented hypocalcemia. A 50 % decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73 %, respectively). No patients with a decrease <35 % developed hypocalcemia (100 % sensitivity), and all patients with a decrease >80 % had hypocalcemia (100 % specificity).
Conclusions
PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80 % drop in PTH levels can be safely discharged the day of the surgery.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Cardiac Surgery</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Hypocalcemia - blood</subject><subject>Hypocalcemia - epidemiology</subject><subject>Hypocalcemia - etiology</subject><subject>Incidence</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monitoring, Physiologic</subject><subject>Original Article</subject><subject>Parathyroid Hormone - blood</subject><subject>Patient Discharge</subject><subject>Postoperative Period</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Thoracic Surgery</subject><subject>Thyroidectomy - adverse effects</subject><subject>Thyroidectomy - methods</subject><subject>Time Factors</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><subject>Young Adult</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFPAjEQhRujEUR_gBfTo5fVTtvdBW-EqJiQ6AHPTWlnYckuxbZrsv_eEpSjp5nMfPMy7xFyC-wBGCsfA2OSi4xBnoGQkI3PyBCkyDMuczg_9VIMyFUIW8ZYUU7kJRnwQhRccjkkzbRZO1_HTUsr5ylq3_TU1sFstF8j1VVET6OLuqFx03tXWzTRtT3tQr1b04_lPG3p3qOtTaSbfu-Mbgy2tX5KUxf2Ca-_kYbY2f6aXFS6CXjzW0fk8-V5OZtni_fXt9l0kRkJMmbCTjiisUZKY2E8QcGrgidPQljMBWBVAssF4yw3AIWFcqJLaQSsipXUDMWI3B910wdfHYao2uQIm0bv0HVBQSlYMS6SRELhiJr0bPBYqb2vW-17BUwdQlbHkFUKWR1CVuN0c_cr361atKeLv1QTwI9ASKvdGr3aus7vkuV_VH8AMBaIZg</recordid><startdate>20151001</startdate><enddate>20151001</enddate><creator>Schlottmann, F.</creator><creator>Arbulú, A. L. Campos</creator><creator>Sadava, E. E.</creator><creator>Mendez, P.</creator><creator>Pereyra, L.</creator><creator>Fernández Vila, J. M.</creator><creator>Mezzadri, N. A.</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20151001</creationdate><title>Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study</title><author>Schlottmann, F. ; Arbulú, A. L. Campos ; Sadava, E. E. ; Mendez, P. ; Pereyra, L. ; Fernández Vila, J. M. ; Mezzadri, N. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-3d92eecdc44cd189e32f6224533de531ef710530205c116d179a74c31b6b4a0e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Algorithms</topic><topic>Cardiac Surgery</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Hypocalcemia - blood</topic><topic>Hypocalcemia - epidemiology</topic><topic>Hypocalcemia - etiology</topic><topic>Incidence</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monitoring, Physiologic</topic><topic>Original Article</topic><topic>Parathyroid Hormone - blood</topic><topic>Patient Discharge</topic><topic>Postoperative Period</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Thoracic Surgery</topic><topic>Thyroidectomy - adverse effects</topic><topic>Thyroidectomy - methods</topic><topic>Time Factors</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schlottmann, F.</creatorcontrib><creatorcontrib>Arbulú, A. L. Campos</creatorcontrib><creatorcontrib>Sadava, E. E.</creatorcontrib><creatorcontrib>Mendez, P.</creatorcontrib><creatorcontrib>Pereyra, L.</creatorcontrib><creatorcontrib>Fernández Vila, J. M.</creatorcontrib><creatorcontrib>Mezzadri, N. A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schlottmann, F.</au><au>Arbulú, A. L. Campos</au><au>Sadava, E. E.</au><au>Mendez, P.</au><au>Pereyra, L.</au><au>Fernández Vila, J. M.</au><au>Mezzadri, N. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2015-10-01</date><risdate>2015</risdate><volume>400</volume><issue>7</issue><spage>831</spage><epage>836</epage><pages>831-836</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge.
Methods
We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point.
Results
One hundred and six patients were included. Thirty-six (33.9 %) patients presented hypocalcemia. A 50 % decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73 %, respectively). No patients with a decrease <35 % developed hypocalcemia (100 % sensitivity), and all patients with a decrease >80 % had hypocalcemia (100 % specificity).
Conclusions
PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80 % drop in PTH levels can be safely discharged the day of the surgery.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26362424</pmid><doi>10.1007/s00423-015-1341-8</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdominal Surgery Adult Aged Algorithms Cardiac Surgery Cohort Studies Female Follow-Up Studies General Surgery Humans Hypocalcemia - blood Hypocalcemia - epidemiology Hypocalcemia - etiology Incidence Male Medicine Medicine & Public Health Middle Aged Monitoring, Physiologic Original Article Parathyroid Hormone - blood Patient Discharge Postoperative Period Predictive Value of Tests Prospective Studies Risk Assessment Sensitivity and Specificity Thoracic Surgery Thyroidectomy - adverse effects Thyroidectomy - methods Time Factors Traumatic Surgery Treatment Outcome Vascular Surgery Young Adult |
| title | Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study |
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