Background Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation. Patients and MethodsWe performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p B 0.05. Results Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1-2 glands: 13.3%; p \ 0.0001) [OR for 1-2 glands in situ = 5.32, CI 95% 2.61-10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56,, concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46-6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85-7.02). Conclusions Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).

Background Permanent hypoparathyroidism (PH) is the most frequent long-term complication after total thyroidectomy. PH is related to many short-term and long-term complications, including clinical manifestations of hypocalcemia, hypercalcemia due to overtreatment, hyperphosphatemia, gastrointestinal, neuropsychiatric symptoms, decrease in renal function and infectious complications. The aim of this study was to identify the most frequent effects of PH and its associated risk factors. Methods We performed a retrospective analysis of a single institutional series of patients who developed PH after total thyroidectomy between 2000 and 2016. PH was defined as hypoparathormonemia (B12 pg/mL) or the need for calcium/vitamin D supplementation to achieve normal calcium levels for more than 12 months. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Results Thirty-nine patients fulfilled the criteria for PH. Mean ± SD age was 46.26 ± 13.4 years; 6 (15.4%) were males and 33 (84.6%) females. Mean follow-up was 6.13 ± 3.25 years. Mean calcium carbonate supplementation doses per day were 18.95 ± 17.5 g and 21.4 ± 19.3 g at 1 year and last follow-up, respectively. Hypocalcemic crisis was the most common complication (66.7%), followed by neuropsychiatric (38.5%) and gastrointestinal symptoms (33.3%). Ten patients showed a decrease in renal function (eGFR drop C25%) and 4 developed chronic kidney disease. The amount of calcium supplementation was the most relevant related risk factor. Conclusions PH is associated with multiple complications, including renal function impairment, gastrointestinal, neuropsychiatric and infectious complications. Lower calcium supplementation doses are related to lower complications rates.

In the original version of the article, the last three column headings in Table 3 were mislabeled. The original article has been corrected. Following is the corrected table:

Introducción: La Pielonefritis Enfisematosa (PE) es una infección necrotizante del tracto urinario superior, asociada a enterobacterias con una evolución subaguda e insidiosa. El diagnóstico es clínico, corroborándose y estadificándose mediante estudio tomográfico. El manejo dependerá de la gravedad del caso, puede ameritar manejo antimicrobiano y vigilancia hasta nefrectomía de urgencia. Objetivo: Describir los factores asociados a gravedad para PE en la población atendida en el servicio de Urología del Hospital General de México. Material y métodos: Estudio observacional, retrospectivo, analítico, obteniéndose para variables cualitativas frecuencias simples y distribución porcentual; para variables cuantitativas, se obtuvieron medidas de tendencia central; para variables con distribución no normal, se obtuvieron mediana y rango intercuartil. La comparación entre grupos se realizó mediante prueba exacta de Fisher (variables cualitativas), y test de U de Mann Whitney e intervalos de confianza al 95% (IC 95%) (variables cuantitativas). La estadística inferencial utilizó razón de momios (RM) para obtener la relación de cada factor para gravedad. Los cálculos fueron realizados con un nivel de confiabilidad de 95% y error alfa de 5%. Resultados: Los factores asociados a gravedad para PE son: bilateralidad (RM 7.5, IC 95 % 1.56-36.8, p 0.011), cólico nefrítico (RM 2.9, IC 95 % 0.70-12.4, p 0.01), leucocitosis (RM 1.5, IC 95 % 0.44-4.92, p 0.04), trombocitopenia (RM 3.2, IC 95% 0.29-34.7, p 0.04), Glasgow <15 (RM 1.3, IC 95 % 0.31-3.39, p 0.001) y Azoemia (RM 1.5, IC 95% 0.44-4.92, p 0.04). Conclusión: La temprana identificación de estos factores permitirá disminuir el riesgo de complicaciones y mejorar la evolución de los pacientes con PE.

Introducción: La Pielonefritis Enfisematosa (PE) es una infección necrotizante del tracto urinario superior, asociada a enterobacterias con una evolución subaguda e insidiosa. El diagnóstico es clínico, corroborándose y estadificándose mediante estudio tomográfico. El manejo dependerá de la gravedad del caso, puede ameritar manejo antimicrobiano y vigilancia hasta nefrectomía de urgencia. Objetivo: Describir los factores asociados a gravedad para PE en la población atendida en el servicio de Urología del Hospital General de México. Material y métodos: Estudio observacional, retrospectivo, analítico, obteniéndose para variables cualitativas frecuencias simples y distribución porcentual; para variables cuantitativas, se obtuvieron medidas de tendencia central; para variables con distribución no normal, se obtuvieron mediana y rango intercuartil. La comparación entre grupos se realizó mediante prueba exacta de Fisher (variables cualitativas), y test de U de Mann Whitney e intervalos de confianza al 95% (IC 95%) (variables cuantitativas). La estadística inferencial utilizó razón de momios (RM) para obtener la relación de cada factor para gravedad. Los cálculos fueron realizados con un nivel de confiabilidad de 95% y error alfa de 5%. Resultados: Los factores asociados a gravedad para PE son: bilateralidad (RM 7.5, IC 95 % 1.56-36.8, p 0.011), cólico nefrítico (RM 2.9, IC 95 % 0.70-12.4, p 0.01), leucocitosis (RM 1.5, IC 95 % 0.44-4.92, p 0.04), trombocitopenia (RM 3.2, IC 95% 0.29-34.7, p 0.04), Glasgow <15 (RM 1.3, IC 95 % 0.31-3.39, p 0.001) y Azoemia (RM 1.5, IC 95% 0.44-4.92, p 0.04). Conclusión: La temprana identificación de estos factores permitirá disminuir el riesgo de complicaciones y mejorar la evolución de los pacientes con PE.