Factors Predicting Hypocalcemia After Total Thyroidectomy. The CESQIP Experience
*Eva Fuentes, *Sean Wrenn, *Asmae Toumi, *Carrie C Lubitz, *Sareh Parangi, Antonia E Stephen
Massachusetts General Hospital, Cambridge, MA
Objective: To identify factors associated with clinically significant post-thyroidectomy hypocalcemia using a large national database that captures both inpatient and outpatients.
Design: Retrospective review comparing post-thyroidectomy patients with concern for post-operative hypoparathyroidism versus those without. A subgroup analysis of hypocalcemic patients was performed, comparing those receiving IV calcium versus oral supplementation alone.
Setting: The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) is comprised of 48 collaborating sites in the country, mostly tertiary academic centers. Both inpatient and outpatient cases were captured Patients: Patients that underwent total thyroidectomy entered in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database (2012-2019).
Interventions: none Main Outcome Measures: Clinical concern for hypocalcemia
Results: There was a total of 11,374 total thyroidectomies recorded. There was concern for hypoparathyroidism in 7.9% of cases (N=903). These patients were younger (p<0.001), more commonly females (p<0.001) and had BMI’s < 40 (p=0.004). Hypocalcemic patients were significantly more likely to have hyperthyroidism preoperatively (25% vs 20%, p<0.001) and more frequently had cancer on final pathology (53% vs 45%,p<.001). Central neck dissection (CND) and parathyroid auto transplantation were significantly more common in the hypocalcemia group (33% vs 20% and 27% vs 16% respectively p<0.001). In a multivariable logistic regression, all the above variables were found to be independently associated with hypocalcemia. Remedial surgery was equally common in both groups (2%). Intravenous calcium was administered in 15% of the hypocalcemic patients (135/903).
Conclusions: Patients with pre-operative hyperthyroidism as well as patients with cancer undergoing CND are more likely to develop post-operative hypocalcemia. This should be considered regarding the monitoring and administration of post-operative calcium and vitamin D.
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