Operative Treatment of Primary Hyperparathyroidism in Daycare Surgery

Dulfer, R. R.; Ginhoven, Tessa M. van; Geilvoet, Wanda; Herder, Wouter W. de; Eijck, Casper H.J. van

doi:10.1177/1457496914557015

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…At study inclusion and at discharge after thyroidectomy, patients were counseled about hypocalcemic symptoms. Increased awareness and focus on physical sensations may have caused the higher number of patients seeking medical care ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

A symptom-based algorithm for calcium management after thyroid surgery: a prospective multicenter study

van Kinschot,

Lončar,

van Ginhoven

et al. 2023

European Thyroid Journal

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Objective: Evidence based treatment guidelines for the management of post-thyroidectomy hypocalcemia are absent. The aim of this study was to evaluate a newly developed symptom-based treatment algorithm including a protocolized attempt to phase out supplementation. Methods: In a prospective multicenter study, patients were treated according to the new algorithm and compared to a historical cohort of patients treated with a biochemically-based approach. The primary outcome was the proportion of patients receiving calcium and/or alphacalcidol supplementation. Secondary outcomes were calcium-related complications and predictors for supplementation. Results: 134 patients were included prospectively, and compared to 392 historical patients. The new algorithm significantly reduced the proportion of patients treated with calcium and/or alphacalcidol during the first postoperative year (OR 0.36 [95% CI 0.23 – 0.54], p<0.001), and persistently at 12 months follow-up (OR 0.51 [0.28 - 0.90], p<0.05). No severe calcium-related complications occurred, even though calcium-related visits to the emergency department and readmissions increased (OR 11.5 [4.51 – 29.3], p<0.001) and (OR 3.46 [1.58 – 7.57], p<0.05), respectively. The proportional change in pre- to postoperative parathyroid hormone (PTH) was an independent predictor for supplementation (OR 1.04 [1.02 - 1.07], p<0.05). Conclusions: Symptom-based management of post-thyroidectomy hypocalcemia and a protocolized attempt to phase out supplementation safely reduced the proportion of patients receiving supplementation, although the number of calcium-related hospital visits increased. For the future, we envision a more individualized treatment approach for patients at risk for delayed symptomatic hypocalcemia, including the proportional change in pre- to postoperative PTH.

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Section: Discussionmentioning

confidence: 99%

A symptom-based algorithm for calcium management after thyroid surgery: a prospective multicenter study

van Kinschot,

Lončar,

van Ginhoven

et al. 2023

European Thyroid Journal

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“…11 12 Several studies have demonstrated that same-day discharge after parathyroidectomy is feasible with low rates of postoperative complications. 3 4 5 6 7 8 10 13 14 15 16 Importantly, these reports acknowledge that accelerated discharge pathways are not appropriate for all patients undergoing parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“… 2 3 Despite these concerns, several studies from high-volume, academic centers have demonstrated that parathyroidectomy can be safely performed with discharge on the day of surgery or on the 1 st postoperative day. 3 4 5 6 7 8 9 10 The purpose of the present study was to report the results of parathyroidectomy at a 'medium-volume' endocrine unit in a District General Hospital setting before and after the implementation of a protocol intended to reduce the postoperative length of stay (LOS) by focusing on periprocedural patient education and postoperative management of calcium monitoring and supplementation.…”

Section: Introductionmentioning

confidence: 99%

Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

Sinha

Fok

Ahmad

et al. 2019

Int Arch Otorhinolaryngol

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Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

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“…It should be hoped to identify selection strategies of the patients that need some specific exams or tools in the perspective of curtailing unnecessary charges. In our specific field, we are convinced that the hospital stay could be reduced at only one overnight in a number of cases, given that the management in one-day surgery and even in day-care surgery have been proposed (34)(35)(36); moreover, we could select the use of the ioPTH and start to perform some MIVAP procedures under local anaesthesia with the aim of reducing the specific charges of the general anaesthesia. These measures could increase the number of cases which cost are under the standard value of the reimbursement.…”

Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

Melfa¹,

Raspanti²,

Attard³

et al. 2016

Gchir

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Primary hyperparathyroidism (PHPT) is the third most frequent disease among the endocrine disorders, with a prevalence of 1-3% in western countries. Moreover, it is the commonest cause of hypercalcemia (1-4). Nowadays, the PHPT is diagnosed increasingly due to the improvement of biochemical test; it allowed the precocious diagnosis and the identification of asymptomatic patients (5, 6). Conventional bilateral neck exploration remains the reference surgical technique, although the hyperproduction of the parathyroid hormone (PTH) is due to a single hyperfunctioning gland (most frequently a parathyroid adenoma) in a high percentage (70-95%) of cases. It could allow to perform a minimally invasive "focused" approach if the preoperative diagnosis of localization is not doubtful, especially in the presence of two concordant imaging procedures, such as ultrasounds (US) and 99mTc-Sestamibi Scintigraphy (MIBI) (2, 7-11). This focused approach can be performed under general as well as local anaesthesia and it is widely accepted for the sporadic, non-hereditary, uni-focal form (4). The goal of a minimally invasive approach can also be reached with the minimally invasive video-assisted parathyroidectomy (MIVAP), which is an adaptation of the mini-incision cervical procedures to the video-assisted gasless techniques (9,12,13

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Operative Treatment of Primary Hyperparathyroidism in Daycare Surgery

Cited by 9 publications

References 12 publications

A symptom-based algorithm for calcium management after thyroid surgery: a prospective multicenter study

A symptom-based algorithm for calcium management after thyroid surgery: a prospective multicenter study

Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

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