Nomogram to Aid Selection of Patients for Short-Stay Thyroidectomy Based on Risk of Postoperative Hypocalcemia

Ali, Safina; Yu, Changhong; Palmer, Frank L.; Ganly, Ian; Shaha, Ashok R.; Shah, Jatin P.; Kattan, Michael W.; Patel, Snehal G.

doi:10.1001/archoto.2011.189

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…The reasons for this may reflect the different populations studied. Rates of malignancy in the US cohort were higher, and patient age was lower than in our population. In an attempt to assess the validity of our data, detailed analysis of our results showed that as expected the presence of malignancy (which is a surrogate for more aggressive surgery) and the presence of parathyroid tissue in the pathological specimen were predictors of hypocalcaemia as was younger patient age.…”

Section: Discussioncontrasting

confidence: 70%

“…All variables required for the published nomogram were available for 57 of 64 patients (89%). The nomogram was used to calculate their individualised probabilities of postoperative hypocalcaemia. The mean nomogram score of those patients who developed a hypocalcaemic event versus those who did not was not significantly different, 48.5% versus 55.5%, respectively, P = 0.89.…”

Section: Resultsmentioning

confidence: 99%

“…Ali et al . described a nomogram to quantify patients' individualised risk of hypocalcaemia based on patient characteristics: age, gender, past medical and medication history, and preoperative investigations: calcium, alkaline phosphatase and creatinine levels.…”

mentioning

confidence: 99%

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Predicting hypocalcaemia post‐thyroidectomy: a retrospective audit of results compared to a previously published nomogram in 64 patients treated at a district general hospital

Kaleva

Hone

Tikka

et al. 2016

Clinical Otolaryngology

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With the increasing incidence of thyroid cancer, 1 total thyroidectomy and completion thyroidectomy are increasingly common in the NHS. Hypocalcaemia is an important complication of these procedures. The reported UK national incidence is 27% for total thyroidectomy and 29% for completion thyroidectomy. 2 Predicting individualised patient risk would allow departments to focus resources on high-risk patients, whilst considering low-risk patients for early discharge.Ali et al. 3 described a nomogram to quantify patients' individualised risk of hypocalcaemia based on patient characteristics: age, gender, past medical and medication history, and preoperative investigations: calcium, alkaline phosphatase and creatinine levels. The nomogram achieved a 68% predictive accuracy in a US tertiary centre (Memorial Sloan Kettering Cancer Center, New York), but has not been tested in a UK population.This study aims to report the rates of hypocalcaemia in a UK district general hospital and assess the clinical utility of the predictive nomogram in this population. Patients and methodsIndividual surgeons' records were used to identify patients who underwent total or completion thyroidectomy between June 2012 and March 2014. Sixty-four patients were identified. Data were collected retrospectively on clinical features (age, gender, medical history and medications), biochemistry (preoperative calcium, creatinine and ALP) and histological findings (weight, thyroiditis, Graves' disease, malignancy and parathyroid tissue in the specimen). The clinical outcomes were any postoperative hypocalcaemia.Hypocalcaemia was defined as corrected ionised calcium level of <2.10 mmol L. 2 A hypocalcaemic event was defined as biochemical hypocalcaemia at 6 and 12 h postoperatively or later. Factors associated with postoperative hypocalcaemia (Ca < 2.10 mmol L) were evaluated in a univariate and multivariate analyses.The nomogram was used to produce a risk of hypocalcaemia score for each individual patient. The mean score of those patients who developed hypocalcaemia was compared to those who did not using the two-tail Student's t-test. In addition, a random sample of 1000 patient pairs was selected and compared to determine whether the nomogram correctly predicted a hypocalcaemic event. The number of times the nomogram correctly predicted the correct patient was divided by the number of pairs tested to generate a concordance index. Hence, a concordance index ranges from 0 to 1.0 where 0.0 and 1.0 are perfect and 0.5 is no better than due to chance alone as in a coin toss.Within the cohort, categorical risk factors were independently analysed using the Pearson's chi-square test or Fisher's exact test. Factors that were associated with a hypocalcaemic event were then tested in a multivariate analysis.Multivariate analysis using binary logistic regression was performed to assess the effect of pre-, intra-and postthyroidectomy factors on the probability of patient developing postoperative hypocalcaemia at 12 h. SAS 9.3. Cary, NC, USA statistical package w...

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Section: Discussioncontrasting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

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Predicting hypocalcaemia post‐thyroidectomy: a retrospective audit of results compared to a previously published nomogram in 64 patients treated at a district general hospital

Kaleva

Hone

Tikka

et al. 2016

Clinical Otolaryngology

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“…89 Nomograms integrating some of these factors can indeed quantitatively predict post-thyroidectomy hypocalcemia at a fairly early stage; however unfortunately, the overall reported accuracy was only 67.7%. 90 Biochemical factors, in terms of perioperative Ca and PTH, have been extensively studied as candidate predictors. Although a postoperative 24 h percent Ca drop 91 or 16 h low adjusted Ca 92 could quantitatively predict post-thyroidectomy hypocalcemia with high accuracy (87 and 90%, respectively), unfortunately, by that time, a symptomatic hypocalcemic episode may already have occurred.…”

Section: Prediction Of the Post-thyroidectomy Calcemic Statementioning

confidence: 99%

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Shawky

2016

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Continuous development of quick parathyroid hormone assays has resulted in a corresponding expansion of their applications in the practical landscape. In-theatre measurement of the parathyroid hormone has long been recognized as a valuable adjunct in parathyroid surgery, with other applications being incorporated in thyroid surgery and out-of-theatre uses. Such widespread utilization of these assays has also brought the concept of point-of-care testing to the endocrine surgical patient. We have herein summarized the established and potential applications of these assays, emphasizing their importance in the point-of-care setting, highlighting the proper selection of the assay type for intraoperative hormone monitoring and spotlighting those applications which should be validated for use in the clinical setting and those which need to be investigated further.

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“…Dois factores frequentemente identificados são o diagnóstico pré-operatorio de malignidade e o número de glândulas paratiroides identificadas per-operatoriamente. [19][20][21] No nosso estudo, estes factores não tiveram influên-cia na incidência de hipocalcemia.…”

Section: 3unclassified

Hormona Paratiróideia Como Factor Predictivo de Hipocalcemia Após Tiroidectomia: Estudo Prospectivo em 100 Doentes

et al. 2015

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Acta Med Port 2015 May-Jun;28(3):322-328 RESUMOIntrodução: A hipocalcemia é uma complicação frequente após tiroidectomia total e o principal motivo pelo internamento prolongado destes doentes. Material e Métodos:Estudaram-se prospectivamente 112 doentes submetidos a tiroidectomia total ou restante entre Junho de 2012 e Novembro de 2013. Foram excluídos 12 casos por apresentarem alterações pré-operatórias da função da paratiróide. Doseou-se a paratormona e cálcio pré-operatórios, imediatamente após a cirurgia, no primeiro dia e no 14º dia após a cirurgia. Resultados: Dos 100 doentes incluídos 60 desenvolveram hipocalcemia (60%), revelando-se sintomática em 14. Surgiu, maioritariamente, 24 horas após a cirurgia (76,7%). Foi definitiva em três doentes e transitória nos restantes. Nos 60 doentes com hipocalcemia, verificou-se hipoparatiroidismo em 19 doentes no doseamento imediatamente após a cirurgia, 14 no doseamento no primeiro dia mas apenas três mantiveram hipoparatiroidismo após 14 dias (doentes com hipocalcemia definitiva). Comparando o grupo de doentes com e sem hipocalcemia constatou-se uma diminuição da paratormona em ambos (imediatamente após a cirurgia e no primeiro dia) mas foi mais importante no grupo com hipocalcemia (p = 0,004 e p < 0,001). O decréscimo da paratormona foi mais acentuado no grupo com hipocalcemia, com maior significado no primeiro dia (50,29% vs 22,47% -p < 0,001). O melhor factor preditivo de hipocalcemia identificado foi o decréscimo da paratormona no primeiro dia após a cirurgia > 19,4% (sensibilidade = 82%; especificidade = 63%). Discussão: No nosso estudo verificou-se uma incidência elevada de hipocalcemia (60%), que se manifestou maioritariamente 24 horas após a cirurgia e que condicionou, nesses doentes, um tempo de internamento mais prolongado. No entanto, em apenas três doentes (3%) a hipocalcemia foi definitiva. Constatou-se ainda uma correspondência na oscilação dos valores séricos do cálcio e da paratormona que permitiu identificar o decréscimo da paratormona no primeiro dia após a cirurgia como um fiável factor predictivo de hipocalcemia. Conclusão: O decréscimo da paratormona no primeiro dia após a cirurgia > 19,4% é um bom factor preditivo de hipocalcemia após tiroidectomia total/restante, permitindo identificar os doentes com maior risco, medicá-los profilaticamente e obter altas precoces e seguras. Palavras-chave: Hipocalcemia; Paratormona; Período Pós-Operatório; Tiroidectomia. ABSTRACT Introduction:Hypocalcemia is a frequent complication after total thyroidectomy and the main reason for prolonged hospitalization of these patients. Material and Methods:We studied prospectively 112 patients who underwent total or completation thyroidectomy between June 2012 and November 2013. Twelve patients with preoperative changes in parathyroid function were excluded. Parathyroid hormone and calcium levels were determined pre-operatively, immediately after surgery, on 1 st day and on 14 th day after surgery. Results: Of the 100 patients enrolled, 60 have developed hypocalcaemia (6...

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Nomogram to Aid Selection of Patients for Short-Stay Thyroidectomy Based on Risk of Postoperative Hypocalcemia

Abstract: We have produced a set of nomograms that can dynamically quantify the risk of postthyroidectomy hypocalcemia and prolonged hospital stay based on preoperative clinical and biochemical variables and intraoperative surgical variables.

Cited by 17 publications

References 23 publications

Predicting hypocalcaemia post‐thyroidectomy: a retrospective audit of results compared to a previously published nomogram in 64 patients treated at a district general hospital

Predicting hypocalcaemia post‐thyroidectomy: a retrospective audit of results compared to a previously published nomogram in 64 patients treated at a district general hospital

Quick parathyroid hormone assays: a comprehensive review of their utility in clinical practice

Hormona Paratiróideia Como Factor Predictivo de Hipocalcemia Após Tiroidectomia: Estudo Prospectivo em 100 Doentes

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