Risk factors and effects of Hypocalcemia prior to discharge following thyroidectomy

Risk factors and effects of Hypocalcemia prior to discharge following thyroidectomy:



Publication date: Available online 13 February 2020

Source: American Journal of Otolaryngology

Author(s): Sina J. Torabi, Jonathan M. Avery, Parsa P. Salehi, Yan Lee

Abstract

Purpose

To find patient and surgical characteristics associated with hypocalcemia prior to discharge (HPTD) in thyroidectomy patients.

Materials and methods

In a retrospective analysis of the 2016–2017 National Surgical Quality Improvement Program, eligible total thyroidectomy patients were stratified into cohorts based on development of HPTD. We identified demographic and surgical risk factors for the development of hypocalcemia via binary logistic regression and identified the negative sequelae of HPTD utilizing univariate and multivariate methods.

Results

We identified a total of 6519 patients who underwent total thyroidectomy, of which 450 (6.9%) had HPTD. Predictors associated with an increased incidence of HPTD included female sex (OR: 1.737 [95% CI: 1.319–2.288]; p < .001), increased operative time (OR: 1.003 [1.002–1.004]; p < .001), and central neck dissection (OR: 1.484 [1.190–1.850]; p < .001). However, factors that decreased incidence of HPTD included increased age, obesity (OR: 0.648 [0.501–0.837]; p = .001), and the use of vessel sealant devices (VSD) (OR: 0.650 [0.527–0.803]; p < .001). Multivariate analysis further revealed that HPTD independently led to an increased hospitalization length after surgery (B: 0.708 [0.607–0.809]; p < .001) and an increased 30-day readmission rate (OR: 2.429 [1.594–3.704]; p < .001).

Conclusion

Obesity, increased age, and intra-operative VSD use were significantly associated with decreased rates of HPTD after total thyroidectomy. Female gender, longer operations, and central neck dissections were associated with HPTD. Delineating risk factors and protective factors for HPTD in total thyroidectomy patients is important as patients with HPTD were found to be at a significantly higher risk for longer post-operative stays, increased odds of 30-day readmission, and increased hypocalcemia-related event.