Prolonged Hospital Stay After Parathyroidectomy for Secondary Hyperparathyroidism

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2008 Oct 28

PMID 18953601

Citations 19

Authors

Shih-Ping Cheng

Chien-Liang Liu

Han-Hsiang Chen

Jie-Jen Lee

Tsang-Pai Liu

Tsen-Long Yang

Affiliations

Soon will be listed here.

Abstract

Background: Protracted hypocalcemia is the most common complication after parathyroidectomy for secondary hyperparathyroidism. Several parameters have been identified to predict the degree of postoperative hypocalcemia. The purpose of this study was to determine whether there were any factors associated with prolonged hospitalization in these patients.

Methods: A total of 81 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between January 2004 and December 2006 were studied. The postoperative calcium infusion protocol and discharge criteria were standardized. Clinical variables were compared between patients with a shorter or longer postoperative stay.

Results: The mean postoperative hospital stay was 5.6 days. Preoperative alkaline phosphatase levels were significantly higher in patients with a longer stay (p=0.035). In a linear regression model, the postoperative length of stay was moderately but significantly correlated with preoperative alkaline phosphatase levels (R2=0.254; p<0.001). Receiver operating characteristic analysis showed a significant area under the curve (0.678; 95% confidence interval 0.550-0.805; p=0.014). With a cutoff of preoperative alkaline phosphatase levels at 200 IU/L, the sensitivity was 0.57 and the specificity was 0.59 for predicting a prolonged stay.

Conclusions: A high preoperative alkaline phosphatase level is significantly associated with prolonged hospital stay in patients undergoing parathyroidectomy for secondary hyperparathyroidism.

Citing Articles

A nomogram prediction model for hungry bone syndrome in dialysis patients with secondary hyperparathyroidism after total parathyroidectomy.

Gao D, Liu Y, Cui W, Lu X, Lou Y Eur J Med Res. 2024; 29(1):208.

PMID: 38549160 PMC: 10976803. DOI: 10.1186/s40001-024-01801-y.

Abnormalities of serum magnesium levels in dialysis patients undergoing parathyroidectomy.

Kuo C, Tsai C, Lee J, Cheng S Updates Surg. 2024; 76(4):1435-1441.

PMID: 38480639 DOI: 10.1007/s13304-024-01790-x.

Intensive Calcium Monitoring Following Parathyroidectomy: Prevention of Hungry Bone Syndrome in Children.

Jose Garcia Diaz F, Beth Martin L, Lucia Gomez Gila A, Navarro Moreno C Turk Arch Pediatr. 2024; 59(1):109-111.

PMID: 38454268 PMC: 10837522. DOI: 10.5152/TurkArchPediatr.2024.23205.

Neck Reoperation for Recurrent or Persistent Renal Hyperparathyroidism.

Chang L, Liu S, Liang T World J Surg. 2023; 47(11):2784-2791.

PMID: 37714965 DOI: 10.1007/s00268-023-07172-5.

Calcitriol supplementation before parathyroidectomy and calcium level after surgery in parathyroid adenoma patients: a randomized controlled trial.

Shahriarirad R, Meshkati Yazd S, Ardekani A, Mokhtari Ardekani A, Moradi N, Nasiri S J Endocrinol Invest. 2022; 46(5):985-990.

PMID: 36459369 DOI: 10.1007/s40618-022-01963-8.

References

Tominaga Y, Matsuoka S, Sato T . Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial. 2005; 9(1):44-7. DOI: 10.1111/j.1774-9987.2005.00213.x. View

Wang M, Hercz G, Sherrard D, Maloney N, Segre G, Pei Y . Relationship between intact 1-84 parathyroid hormone and bone histomorphometric parameters in dialysis patients without aluminum toxicity. Am J Kidney Dis. 1995; 26(5):836-44. DOI: 10.1016/0272-6386(95)90453-0. View

Mittendorf E, Merlino J, McHenry C . Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg. 2004; 70(2):114-9. View

Delmonico F, Wang C, Rubin N, Fang L, Herrin J, Cosimi A . Parathyroid surgery in patients with renal failure. Ann Surg. 1984; 200(5):644-7. PMC: 1250550. DOI: 10.1097/00000658-198411000-00015. View

Cheng S, Chang Y, Liu C, Yang T, Jeng K, Lee J . Factors associated with prolonged stay after laparoscopic cholecystectomy in elderly patients. Surg Endosc. 2007; 22(5):1283-9. DOI: 10.1007/s00464-007-9610-4. View

. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

Jofre R, Lopez Gomez J, Menarguez J, Polo J, Guinsburg M, Villaverde T . Parathyroidectomy: whom and when?. Kidney Int Suppl. 2003; (85):S97-100. DOI: 10.1046/j.1523-1755.63.s85.23.x. View

Kinnaert P, Tielemans C, DHaene M . Evaluation of surgical treatment of renal hyperparathyroidism by measuring intact parathormone blood levels on first postoperative day. World J Surg. 1998; 22(7):695-9. DOI: 10.1007/s002689900455. View

Nakagawa M, Emoto A, NASU N, Hirata Y, Sato F, Li W . Calcium supplement necessary to correct hypocalcemia after total parathyroidectomy for renal osteodystrophy. Int J Urol. 2000; 7(2):35-40. DOI: 10.1046/j.1442-2042.2000.00136.x. View

10.

Lo C, Luk J, Tam S . Applicability of intraoperative parathyroid hormone assay during thyroidectomy. Ann Surg. 2002; 236(5):564-9. PMC: 1422613. DOI: 10.1097/00000658-200211000-00005. View

11.

Cruz D, Perazella M . Biochemical aberrations in a dialysis patient following parathyroidectomy. Am J Kidney Dis. 1997; 29(5):759-62. DOI: 10.1016/s0272-6386(97)90131-1. View

12.

Lorenz K, Ukkat J, Sekulla C, Gimm O, Brauckhoff M, Dralle H . Total parathyroidectomy without autotransplantation for renal hyperparathyroidism: experience with a qPTH-controlled protocol. World J Surg. 2006; 30(5):743-51. DOI: 10.1007/s00268-005-0379-0. View

13.

Sitges-Serra A . Hyperparathyroidism associated with renal disease. Pathogenesis, natural history, and surgical treatment. Surg Clin North Am. 1987; 67(2):359-77. DOI: 10.1016/s0039-6109(16)44189-7. View

14.

Lin C, Hsieh K, Yeh M, Sheen-Chen S, Chou F . Skin necrosis after intravenous calcium chloride administration as a complication of parathyroidectomy for secondary hyperparathyroidism: report of four cases. Surg Today. 2007; 37(9):778-81. DOI: 10.1007/s00595-006-3426-z. View

15.

Gasparri G, Camandona M, Abbona G, Papotti M, Jeantet A, Radice E . Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg. 2001; 233(1):65-9. PMC: 1421168. DOI: 10.1097/00000658-200101000-00011. View

16.

Yajima A, Ogawa Y, Takahashi H, Tominaga Y, Inou T, Otsubo O . Changes of bone remodeling immediately after parathyroidectomy for secondary hyperparathyroidism. Am J Kidney Dis. 2003; 42(4):729-38. DOI: 10.1016/s0272-6386(03)00909-0. View

17.

Richards M, Wormuth J, Bingener J, Sirinek K . Parathyroidectomy in secondary hyperparathyroidism: Is there an optimal operative management?. Surgery. 2006; 139(2):174-80. DOI: 10.1016/j.surg.2005.08.036. View

18.

Chandran P, Ulahannan T, Skiles M . Biochemical changes following parathyroidectomy. Int J Artif Organs. 1993; 16(10):700-3. View

19.

Schomig M, Ritz E . Management of disturbed calcium metabolism in uraemic patients: 2. Indications for parathyroidectomy. Nephrol Dial Transplant. 2000; 15 Suppl 5:25-9. DOI: 10.1093/ndt/15.suppl_5.25. View

20.

Benz R, Schleifer C, Teehan B, SIGLER M, Gilgore G . Successful treatment of postparathyroidectomy hypocalcemia using continuous ambulatory intraperitoneal calcium (CAIC) therapy. Perit Dial Int. 1989; 9(4):285-8. View