The aim of this study is to evaluate the additional costs associated with calcium monitoring and treatment as well as evaluate the incidence and predictors of postthyroidectomy hypocalcemia. Methods. This case-control study involved thyroidectomy and completion thyroidectomy patients operated on between January 2012 and August 2013. Cases were defined as requiring calcitriol supplementation, and controls did not require supplementation. Patient (age, sex), nodule (cytology, pathology), surgical data (neck dissection, parathyroid identification, and reimplantation), and hospital stay (days hospitalized in total and after drain removal) were compared. Comparisons were made using -tests and chi-square tests with an alpha of 0.05. The estimated cost associated with the extended stay was then compared with the cost of supplementation. Results. A total of 191 patients were evaluated (61 cases and 130 controls). Predictors of hypocalcemia include female age, neck dissection, and parathyroid reimplantation. Hypocalcemic patients were hospitalized for a longer period of time after drain removal (2.5 versus 0.8 days, ), and hospitalization costs after neck drain removal were higher in this group as well (8,367.32$ versus 2,534.32$, ). Conclusion. Postoperative hypocalcemia incurs significant additional health care costs at both the local and health care system levels. 1. Introduction As thyroid cancer has the most rapidly rising incidence rate of all major cancers in Canada [1], surgeons will likely be performing an increasing number of thyroidectomies in the foreseeable future. One of the major complications following completion and total thyroidectomy is postoperative hypocalcemia [2], which is mainly due to hypoparathyroidism when the parathyroid glands are put at risk of devascularization, with incidence rates of up to 33% being reported in centers where it is managed only on the basis of clinical observation and calcium monitoring [3]. Although some research has focused on developing protocols and guidelines to reduce the incidence of postoperative hypocalcemia [4–6], there is very little data on the economic impact of the monitoring and treatment of postthyroidectomy hypocalcemia in Canada. The current standard of practice at our tertiary hospital center is of postoperative serum calcium monitoring and treatment of hypocalcemia when necessary. The aim of this study is to evaluate the incidence and the predictors of postoperative hypocalcemia following thyroid surgery as well as to evaluate the additional cost of prolonged hospitalization incurred by the
References
[1]
Canadian Cancer Society’s Advisory Committee on Cancer Statistics, “Canadian Cancer Statistics 2013 Special topic: Liver cancer. [S.l.],” Canadian Cancer Society; 2013, http://myaccess.library.utoronto.ca/login?url=http://site.ebrary.com/lib/utoronto/Top?id=10746792.
[2]
L. Rosato, N. Avenia, P. Bernante et al., “Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years,” World Journal of Surgery, vol. 28, no. 3, pp. 271–276, 2004.
[3]
V. Cote, N. Sands, M. P. Hier, et al., “Cost savings associated with post-thyroidectomy parathyroid hormone levels,” Otolaryngology—Head and Neck Surgery, vol. 138, no. 2, pp. 204–208, 2008.
[4]
D. Glinoer, G. Andry, G. Chantrain, and N. Samil, “Clinical aspects of early and late hypocalcaemia after thyroid surgery,” European Journal of Surgical Oncology, vol. 26, no. 6, pp. 571–577, 2000.
[5]
R. J. Payne, M. A. Tewfik, M. P. Hier et al., “Benefits resulting from 1- and 6-hour parathyroid hormone and calcium levels after thyroidectomy,” Otolaryngology—Head and Neck Surgery, vol. 133, no. 3, pp. 386–390, 2005.
[6]
A. Alhefdhi, H. Mazeh, and H. Chen, “Role of postoperative vitamindand/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: asystematic review and meta-analysis,” The Oncologist, vol. 18, no. 5, pp. 533–542, 2013.
[7]
P. W. Flint and C. W. Cummings, Cummings Otolaryngology—Head & Neck Surgery, Mosby/Elsevier, Philadelphia, Pa, USA, 5th edition, 2010.
[8]
B. Abboud, G. Sleilaty, C. Braidy et al., “Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery,” Archives of Otolaryngology: Head and Neck Surgery, vol. 133, no. 11, pp. 1105–1110, 2007.
[9]
N. B. Sands, R. J. Payne, V. C？té, M. P. Hier, M. J. Black, and M. Tamilia, “Female gender as a risk factor for transient post-thyroidectomy hypocalcemia,” Otolaryngology—Head and Neck Surgery, vol. 145, no. 4, pp. 561–564, 2011.
[10]
A. AlQahtani, A. Parsyan, R. Payne, and R. Tabah, “Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia,” Canadian Journal of Surgery, vol. 57, no. 4, pp. 237–240, 2014.
[11]
T. N. Le, P. D. Kerr, D. E. Sutherland, and P. Lambert, “Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia,” Journal of Otolaryngology—Head and Neck Surgery, vol. 43, article 5, 2014.
[12]
T. S. Wang, K. Cheung, S. A. Roman, and J. A. Sosa, “To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy,” Annals of Surgical Oncology, vol. 18, no. 5, pp. 1293–1299, 2011.
