Optimisation of a protocol for detection and management of post-parathyroidectomy hypocalcaemia

Abstract Background Hypocalcaemia is the most common complication after parathyroid surgery. The aim of this project was to evaluate effectiveness currently used departmental protocol in detecting and managing patients with post-parathyroidectomy hypocalcaemia. Methods All consecutive who underwent first-time parathyroidectomy (without concomitant thyroidectomy) for primary hyperparathyroidism a UK tertiary centre between October 2017 March 2019 were included. Data on demographics, perioperative biochemistry, adherence current (treatment if PTH less than 1.6pmol/L or adj. calcium 2.1mmol/L day 1 post-op) short-term clinical outcomes collected analysed. Results Of 189 patients, 75% female. median (inter-quartile range) age 59 (50–70) years. 181 (96%) cured. Ninety-eight bilateral neck exploration (BNE) 91 targeted parathyroidectomy/ unilateral (TP/UNE) done. rate 88%. 4 (2%) reattended hospital within 30 days due hypocalcaemia; At first follow up, 3 (1.5%) had hypocalcaemia (adjusted < 2.1 mmol/L) despite treatment discharge. Three related hypercalcaemia. Using protocol, 61% did not require any supplements When compared TP/UNE, BNE has higher overall risk complications (14.2% vs 4% respectively; p=0.034) failure (7% 1% p=0.02). Conclusion This reliable identifying at post avoids unnecessary supplementation. Further modifications (including avoidance active vitamin D TP/UNE prophylactic select cohorts) will be introduced potentially reduce hypo- hypercalcaemia even further.