Safety, efficacy, and cost savings of single parathyroid hormone measurement for risk stratification after total thyroidectomy.

Abstract

The management of hypocalcemia (HC) after total thyroidectomy (TTx) is a challenge as TTx is transitioned into a same-day surgery. Measurement of parathyroid hormone (PTH) level after TTx may allow for prediction of postoperative HC and lead to shorter hospital stays. A prospective database was queried between January 2010 and June 2012 with 95 patients who had undergone TTx identified. Patient demographics; preoperative diagnosis; laboratory values and cost; complications; intravenous calcium supplementation; and length of stay (LOS) were analyzed. A PTH-based algorithm was retrospectively applied and theoretical cost savings were analyzed in terms of laboratory cost, LOS, and total cost. Ninety-five patients underwent TTx: 37 patients (38.9%) had cancer, whereas 27 (28.4%) had Graves' disease and the remaining 31 (32.6%) had a benign multinodular goiter. Postoperative PTH was recorded in 72 patients (74.4%); 46 (63.8%) had PTH greater than 10 pg/mL and 26 (36.9%) had PTH less than 10 pg/mL. Transient HC occurred in 10 patients (38.4%) with PTH less than 10 pg/mL (relative risk, 17.69; P = 0.0001). Patients with PTH less than 10 pg/mL incurred a 14.9 per cent higher hospital cost compared with those with PTH greater than 10 pg/mL. With retrospective implementation of the algorithm, there is a potential 46.4 per cent cost savings for the PTH less than 10 pg/mL group, 67.3 per cent savings for the PTH greater than 10 pg/mL group, and 46.7 per cent savings when taken altogether. Algorithmic risk stratification based on postoperative PTH less than 10 pg/mL serves as both a sensitive (100%) and specific (76.7%) predictor of postoperative HC. Such risk stratification may allow for same-day discharge in a number of patients, and even in patients requiring an overnight stay, result in cost savings as a result of a reduction in laboratory expenditures.

• Authors: Meghan McCullough, Collin Weber, Chris Leong, Jyotirmay Sharma
• Journal: The American surgeon (Am Surg) Vol. 79 Issue 8 Pg. 768-74 (Aug 2013) ISSN: 1555-9823 [Electronic] United States
• PMID: 23896242 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Biomarkers
• Parathyroid Hormone

Topics

• Adult
• Algorithms
• Biomarkers (blood)
• Cost Savings (statistics & numerical data)
• Decision Support Techniques
• Female
• Georgia
• Hospital Costs (statistics & numerical data)
• Humans
• Hypocalcemia (blood, diagnosis, economics, etiology)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Postoperative Care (economics, methods)
• Postoperative Complications (blood, diagnosis, economics)
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Thyroidectomy