Selective prophylactic calcium supplementation reduces length of stay after total thyroidectomy

Abstract

Introduction: Hypocalcemia is a common complication of thyroidectomy. We aimed to assess compliance with a targeted calcium and calcitriol supplementation protocol and hypothesized that it would allow safe early discharge without an increase in readmissions. Materials and methods: In 2009, we instituted a targeted early postoperative calcium and calcitriol supplementation protocol based on postoperative parathyroid hormone (PTH). We retrospectively reviewed all patients who had a total or completion thyroidectomy over a 4-year period prior to protocol implementation (group I: 2005–2008) and over a 5-year period after protocol implementation (group II: 2010–2014), as well as all patients operated on in the private setting with the senior author over a 1-year period (group III: 2013). Endpoints for analysis were clinically significant hypocalcemia, protocol compliance, hospital length of stay (LOS), and readmission for hypocalcemia. Results: Compliance with the protocol was high; however, the accuracy of supplementation prescription was significantly lower in group II than in group III (p < 0.0001). Mean corrected calcium on postoperative day 1 was significantly higher in groups II (2.29 mmol/L) and III (2.27 mmol/L) compared with group I (2.15 mmol/L; p < 0.0001). Forty (30.5%) patients had clinically significant hypocalcemia in group I, compared with 21 (10.8%) in group II, and 2 (3.3%) in group III (p < 0.0001). The LOS was significantly decreased after protocol introduction (p < 0.0001). Conclusion: Selective prophylactic calcium supplementation reduces LOS after total thyroidectomy. Clinical significance: Introducing a new management protocol in the public hospital system poses challenges with compliance; however, it was successful in lowering rates of symptomatic hypocalcemia and LOS without an increase in the readmission rate.