Risk Stratification for Outpatient Parathyroidectomy and Predictors of Postoperative Complications

Publication date: Available online 28 September 2016
Source:American Journal of Otolaryngology
Author(s): Sarah M. Kidwai, Arjun K. Parasher, Yan W. Ho, Marita S. Teng, Eric M. Genden
IntroductionThe mainstay of treatment for primary hyperparathyroidism is surgery. Hypocalcemia after parathyroidectomy is common and poses a significant challenge, leading to increased patient morbidity and health care costs. While several groups have found predictors factors for hypocalcemia, none have created a risk stratification model. Here, we recognize important factors and optimal cut-off values that can allow risk stratification of patients.MethodsA single-institution retrospective chart review of 339 patients that underwent parathyroidectomy from 2009 to 2012 was conducted. Pre-operative, intra-operative, and post-operative data was collected. A non-routine outcome was defined as post-operative admission, outpatient hypocalcemia-related complication, or inpatient hypocalcemia-related complication. The preoperative or intraoperative factors of patients that experienced a non-routine outcome were compared to those that did not. Optimal cut-off values were determined for preoperative and intraoperative factors and a risk stratification method was created.ResultsA total of 39 patients experienced a non-routine outcome including 24 postoperative admissions, 2 inpatient hypocalcemia-related complications, and 17 outpatient hypocalcemia-related complications. Patients with a non-routine outcome displayed a trend towards preoperative hypercalcemia (calcium >11.0mg/dL) than not (p=0.0543). The median preoperative parathyroid hormone (PTH) level was significantly higher among patients with a non-routine outcome (p=0.0037). Furthermore, the median percent decrease in PTH at 20min intraoperatively among patients with a non-routine outcome was significantly higher compared to those that did not (p=0.0421). The optimal cut-off value for preoperative PTH was 129pg/mL and for median percent decrease in intraoperative PTH at 20min was 90.7% for predicting a non-routine outcome. A risk stratification model was created based on this data.ConclusionOur analysis reveals that patients with larger intraoperative decrease in PTH levels (greater than 90.7% drop at 20min), higher preoperative hypercalcemia (greater than 11mg/dL), and higher preoperative PTH levels (greater than 129pg/mL) are more likely to experience a non-routine outcome during outpatient parathyroidectomy. Patients can be risk stratified based on this criteria.



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