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Risk factors for postoperative hypocalcemia

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Abstract

Hypocalcaemia is one of the most common complications after thyroidectomy; however, it is still unclear what preoperative factors could predict this event. The aim of this study was to evaluate the role of risk factors for hypocalcaemia after total thyroidectomy (TT). Consecutive patients who underwent total thyroidectomyat our institution between January 2014 and January 2016 were enrolled. The clinical and pathologic characteristics and surgical details of normocalcemic and hypocalcemic patients were compared. Univariate and multivariate analyses to estimate risk ratio were assessed. A total of 328 patients underwent TT; histology revealed benign and malignant disease in 83 and 17% of cases, respectively. Central-compartment neck dissection (CCND) was performed in 36 subjects (10.9%). Parathyroid glands were observed in 23% (76) of specimens. Laboratory asymptomatic hypocalcaemia was observed in 92 (28%) patients; symptomatic hypocalcaemia occurred in 26 (7.9%). Transient hypocalcaemia has been observed in 48 (14.6%) patients; permanent hypocalcaemia occurred in two subjects (0.6%). On univariate analysis, malignant pathology (p < 0.001), CCND (p < 0.05), female gender (p < 0.001), presence of at least two parathyroid glands in specimens (p < 0.002), and operative time longer than 120 min (p < 0.05) were factors that significantly increased the risk of develo** asymptomatic and transient hypocalcaemia. After logistic regression analysis, malignant pathology (p < 0.000; p < 0.001) and CCND (p < 0.005; p = 0.013) were the significant factors that affected the development of symptomatic and transient hypocalcaemia. The presence of malignant pathology and CCND was found to be significant risks factors for postoperative hypocalcaemia. In patients in whom this pathological features are present, attention should be paid to rapidly start an adequate therapy.

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References

  1. Jacobs JK, Aland JW Jr, Ballinger JF (1983) Total thyroidectomy. A review of 213 patients. Ann Surg 197:542–549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75

    Article  CAS  PubMed  Google Scholar 

  3. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276

    Article  PubMed  Google Scholar 

  4. Pattou F, Combemale F, Fabre S et al (1998) Hypocalcaemia following thyroid surgery: incidence and prediction of outcome. World JSurg 22:718–724

    Article  CAS  Google Scholar 

  5. Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24:971–975

    Article  CAS  PubMed  Google Scholar 

  6. Falk SA, Birken EA, Baran DT (1998) Temporary post thyroidectomy hypocalcaemia. Arch Otol Head Neck Surg 114:168–174

    Article  Google Scholar 

  7. Adams J, Andersen P, Everts E et al (1998) Early postoperative calcium levels as predictors of hypocalcaemia. Laryngoscope 108:1829–1831

    Article  CAS  PubMed  Google Scholar 

  8. Lindblom P, Westerdahl J, Bergenfelz A (2002) Low parathyroid hormone levels after thyroid surgery: a feasible predictor of hypocalcaemia. Surgery 131:515–520

    Article  PubMed  Google Scholar 

  9. Cherian AJ, Ponraj S, Gowri SM, Ramakant P, Paul TV, Abraham DT, Paul MJ (2016) The role of vitamin D in post-thyroidectomy hypocalcaemia: still an enigma. Surgery 159:532–538

    Article  PubMed  Google Scholar 

  10. Docimo G, Tolone S, Conzo G et al (2016) A gelatin-thrombin matrix topical hemostatic agent (floseal) in combination with harmonic scalpel is effective in patients undergoing total thyroidectomy: a prospective, multicenter, single-blind, randomized controlled trial. Surg Innov 23:23–29

    Article  PubMed  Google Scholar 

  11. Docimo G, Tolone S, Ruggiero R et al (2014) Total thyroidectomy with harmonic scalpel combined to gelatin-thrombin matrix hemostatic agent: is it safe and effective? A single-center prospective study. Int J Sur 12(Suppl 1):S209–S212

    Article  Google Scholar 

  12. Calò PG, Medas F, Loi G, Erdas E, Pisano G, Nicolosi A (2016) Feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies. Updates Surg 68(2):155–161

    Article  PubMed  Google Scholar 

  13. Cho JN, Park WS, Min SY (2016) Predictors and risk factors of hypoparathyroidismafter total thyroidectomy. Int J Surg 34:47–52

    Article  PubMed  Google Scholar 

  14. McLeod IK, Arciero C, Noordzij JP, Stojadinovic A, Peoples G, Melder PC, Langley R, Bernet V, Shriver CD (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcaemia after total or completion thyroidectomy. Thyroid 16:259–265

    Article  CAS  PubMed  Google Scholar 

  15. Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, Perret GY (1993) Transient hypocalcaemia after thyroidectomy. Ann Ot Rhin Laryn 102:496–501

  16. Richards ML, Bingener-Casey J, Pierce DD, Strodel WE, Sirinek KR (2003) Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcaemia following thyroidectomy. Arch Surg 138:632–635

    Article  PubMed  Google Scholar 

  17. Payne RJ, Hier MP, Tamilia M (2005) Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels. Head Neck 27:1–7

    Article  PubMed  Google Scholar 

  18. Grodski S, Serpell J (2008) Evidence for the role of perioperative PTH measurement after total thyroidectomy as a predictor of hypocalcaemia. W J Surg 32:1367–1373

  19. Heaney RP, Weaver CM (2003) Calcium and vitamin D. Endocrinol Metab Clin North Am 32:181–194

    Article  CAS  PubMed  Google Scholar 

  20. Heaney RP (2003) Vitamin D, nutritional deficiency, and the medical paradigm. J Clin Endocrinol Metab 88:5107–5108

    Article  CAS  PubMed  Google Scholar 

  21. Tolone S, Bondanese M, Ruggiero R et al (2016) Outcomes of sutureless total thyroidectomy inelderly. Int J Surg 33(Suppl 1):S16–S19

    Article  PubMed  Google Scholar 

  22. Ruggiero R, Docimo L, Tolone S et al (2016) Effectiveness of an advanced hemostatic pad combined with harmonic scalpel inthyroid surgery. A prospective study. Int J Surg 28(Suppl 1):S17–S21

    Article  PubMed  Google Scholar 

  23. Gurrado A, Bellantone R, Cavallaro G et al (2016) Can total thyroidectomy be safely performed by residents?: a comparative retrospective multicenter study. Medicine (Baltimore) 95:e3241

    Article  Google Scholar 

  24. Docimo G, Tolone S, Ruggiero R et al (2013) Total thyroidectomy without prophylactic central neck dissection combined with routine oral calcium andvitamin D supplements: is it a good option to achieve a low recurrence rate avoiding hypocalcaemia? A retrospective study. Minerva Chir 68:321–328

    CAS  PubMed  Google Scholar 

  25. Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, Alesina PF, De Crea C, Traini E, Princi P (2002) Is routine supplementationtherapy (calcium and vitamin D) usefulaftertotalthyroidectomy? Surgery 132:1109–1112

    Article  PubMed  Google Scholar 

  26. Roh JL, Park CI (2006) Routine oral calcium and vitamin D supplements for prevention of hypocalcaemia after total thyroidectomy. Am J Surg 192:675–678

    Article  CAS  PubMed  Google Scholar 

  27. Tolone S, Roberto R, del Genio G et al (2013) The impact of age and oral calcium and vitamin D supplements on postoperative hypocalcaemia after total thyroidectomy. A prospective study. BMC Surg 13(Suppl 2):S11

    Article  PubMed  PubMed Central  Google Scholar 

  28. Docimo G, Tolone S, Pasquali D et al (2012) Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcaemia after total thyroidectomy. G Chir 33:374–378

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, General and Endocrine Surgical Unit, Second University of Naples, Via Pansini 5, 80131, Naples, Italy

    Giovanni Docimo

  2. Department of General Surgery, General and Obesity Surgical Unit, Second University of Naples, Naples, Italy

    Roberto Ruggiero, Giuseppina Casalino, Gianmattia del Genio, Ludovico Docimo & Salvatore Tolone

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  1. Giovanni Docimo
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  2. Roberto Ruggiero
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  3. Giuseppina Casalino
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  4. Gianmattia del Genio
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  5. Ludovico Docimo
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  6. Salvatore Tolone
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Correspondence to Giovanni Docimo.

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The authors declare no conflict of interest related to the subject of this study.

Ethical approval

The study has been approved by the institutional committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All participants gave their informed consent in writing prior to inclusion in the study.

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Docimo, G., Ruggiero, R., Casalino, G. et al. Risk factors for postoperative hypocalcemia. Updates Surg 69, 255–260 (2017). https://doi.org/10.1007/s13304-017-0452-x

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  • DOI: https://doi.org/10.1007/s13304-017-0452-x

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