The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism (2022)

Type of publication:
Conference abstract

*McDonald S.; *Al-Saadi N.; *Chang J.; *Neophytou C.; *Houghton A.

British Journal of Surgery. Conference: Association of Surgeons of Great Britain and Ireland Annual Congress, ASGBI 2022. Liverpool United Kingdom. 109(Supplement 5) (pp v106), 2022. Date of Publication: 2022.

Aims: Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHpT) and is of ten The cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHpT, current guidance recommends a day-case rate of 90% for patients undergoing Surgery for primary hyperparathyroidism. Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHpT. This protocol, developed in conjunction with The renal physicians, involves giving The patients alpha calcidol pre-operatively for 5 days, to minimise The incidence of hypocalcaemia, and close monitoring of The calcium levels post operatively, to permit safe discharge. Method(s): We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHpT between February 2005 and May 2021. All The patients received The alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected. Result(s): 49 patients underwent a total parathyroidectomy during The study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. Reasons for prolonged hospital stay in The remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patients required readmission during The 30-day post-operative period. Conclusion(s): Day-case Surgery for SHpT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.

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