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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2020; 24(03): e313-e318
DOI: 10.1055/s-0039-1698777
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

Sidhartha Sinha 
1   Department of General and Vascular Surgery, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain and Northern Ireland
2   Department of General and Vascular Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom of Great Britain and Northern Ireland
,
Matthew Fok 
1   Department of General and Vascular Surgery, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom of Great Britain and Northern Ireland
,
Ijaz Ahmad
2   Department of General and Vascular Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom of Great Britain and Northern Ireland
,
Mustafa Al-Sheikh
2   Department of General and Vascular Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom of Great Britain and Northern Ireland
,
Christopher Backhouse
2   Department of General and Vascular Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History

20 January 2019

08 September 2019

Publication Date:
13 December 2019 (online)

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Abstract

Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure.

Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP).

Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015.

Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas.

The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p < 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p = 0.999).

Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

Keywords

Parathyroidectomy - length of stay - surgical outcomes - quality improvement - endocrine - head and neck surgery - short stay surgery

Declarations

The present work has been presented in poster form at the 35th Annual Scientific Meeting of the British Association of Endocrine and Thyroid Surgeons.


 

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