Hypocalcemia is a common complication of thyroidectomy. We aimed to assess compliance with a targeted calcium and calcitriol supplementation protocol and hypothesized that it would allow safe early discharge without an increase in readmissions.

In 2009, we instituted a targeted early postoperative calcium and calcitriol supplementation protocol based on postoperative parathyroid hormone (PTH). We retrospectively reviewed all patients who had a total or completion thyroidectomy over a 4-year period prior to protocol implementation (group I: 2005—2008) and over a 5-year period after protocol implementation (group II: 2010—2014), as well as all patients operated on in the private setting with the senior author over a 1-year period (group III: 2013). Endpoints for analysis were clinically significant hypocalcemia, protocol compliance, hospital length of stay (LOS), and readmission for hypocalcemia.

Compliance with the protocol was high; however, the accuracy of supplementation prescription was significantly lower in group II than in group III (p < 0.0001). Mean corrected calcium on postoperative day 1 was significantly higher in groups II (2.29 mmol/L) and III (2.27 mmol/L) compared with group I (2.15 mmol/L; p < 0.0001). Forty (30.5%) patients had clinically significant hypocalcemia in group I, compared with 21 (10.8%) in group II, and 2 (3.3%) in group III (p < 0.0001). The LOS was significantly decreased after protocol introduction (p < 0.0001).

Selective prophylactic calcium supplementation reduces LOS after total thyroidectomy.

Introducing a new management protocol in the public hospital system poses challenges with compliance; however, it was successful in lowering rates of symptomatic hypocalcemia and LOS without an increase in the readmission rate.

Osborne J, Papachristos A, Skandarajah A, Gorelik A, Hng D, Miller J. Selective Prophylactic Calcium Supplementation reduces Length of Stay after Total Thyroidectomy. World J Endoc Surg 2017;9(3):88-93.