scholarly journals EP.WE.103223-hour stay following total parathyroidectomy in renal patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Chris Neophytou ◽  
Jessica Chang ◽  
Emma Howard ◽  
Andrew Houghton
Keyword(s):  
Perioperative Management ◽  
Neck Surgery ◽  
Early Discharge ◽  
Total Parathyroidectomy ◽  
Day Case ◽  
Prolonged Stay ◽  
Careful Patient ◽  
Day Range ◽  
Management Protocol ◽  
End Stage

Abstract Aim Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy. Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise. Methods All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed. Results There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n = 8) or dialysis (n = 4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p = 0.010482 and p = 0.000263 respectively). No 30-day re-admissions were observed Conclusions Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.

Management of Completion and Total Thyroidectomy Patients Based on 1-Hour Postoperative Parathyroid Hormone

2016 ◽  
Vol 82 (10) ◽  
pp. 881-884
Author(s):  
Joshua Park ◽  
Ethan Frank ◽  
Alfred Simental ◽  
Sara Yang ◽  
Christopher Vuong ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Early Discharge ◽  
Vitamin D Supplementation ◽  
Initial Management ◽  
Management Protocol ◽  
Symptomatic Hypocalcemia ◽  
Risk Patients ◽  
One Year

After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.

scholarly journals Endoscopic Transcranial and Intracranial Resection: Case Series and Design of a Perioperative Management Protocol

Skull Base ◽  
2010 ◽  
Vol 21 (01) ◽  
pp. 013-022 ◽  
Author(s):  
Evan Ransom ◽  
John Lee ◽  
John Lee ◽  
James Palmer ◽  
Alexander Chiu
Keyword(s):  
Perioperative Management ◽  
Case Series ◽  
Management Protocol

scholarly journals Elective total parathyroidectomy without autotransplant in end-stage renal disease

1989 ◽  
Vol 35 (6) ◽  
pp. 1390-1399 ◽  
Author(s):  
Michael Kaye ◽  
Pierre D'Amour ◽  
Janet Henderson
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Total Parathyroidectomy ◽  
Stage Renal Disease ◽  
End Stage

Early Discharge After Trans-radial Day Case Coronary Angiography is Safe and Feasible

2010 ◽  
Vol 19 ◽  
pp. S214
Author(s):  
S. Gamble ◽  
A. Hutchison ◽  
B. Dundon ◽  
M. Lawrence ◽  
J. Potvin ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Early Discharge ◽  
Day Case

scholarly journals Last Resort Salvage of Failed Below Knee Amputations

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Michael Strauss
Keyword(s):  
Knee Joint ◽  
Knee Extension ◽  
Knee Joints ◽  
Knee Amputation ◽  
Pin Fixation ◽  
Management Protocol ◽  
Innovative Management ◽  
Muscle Fascia ◽  
End Stage ◽  
And Function

Category: Other Introduction/Purpose: The consequences of failed transtibial amputations especially if the remaining tibia is less than 5 cm is revision to an above knee amputation (AKA). This has important ramifications regarding mobility, energy requirements for ambulation and function. An innovative management protocol has been employed to maximize the likelihood of healing and maintaining a functional knee joint. Methods: Five severely vasculopathic patients with failed short transtibial (TT) amputations and greater than 60 degree knee flexion contractures were followed progressively using the protocol of resecting the remaining fibula, releasing the hamstring insertions, debridement of bursa & cicatrix, osteotomy & beveling of the distal end of the tibia, creative flap closures, and maintenance of knee extension with pins or external fixation across the knee joint. The patient’s courses were followed prospectively. All patients were referred for more proximal amputations, but wanted everything possible be done to salvage their knee joints and avoid AKAs. Four of the five patients were diabetic; one was a smoker with osteomyelitis at the end of the tibia. Results: Salvage of the knee joint occurred in 4 of 5 patients (80%) even though the remaining tibia lengths were 5 cm or less. Threaded 3/16th inch Steinmann pins placed cross-wise through the knee joints were used in 4 patients and an external fixator in a 5th patient. The pins remained for 3 to 6 weeks. Four of the 5 patients achieved healing with 2 of the 4 having initial minor wound dehiscences. The failed case occurred in a diabetic patient with renal failure and only collateral circulation below the groin. There was insufficient viable muscle/fascia in this patient to cover the tibia. The 4 patients who avoided an AKA were able to be fitted with TT prostheses and use them in a functional capacity. Conclusion: The use of temporary pin fixation across the knee joint and removal of the remaining fibula to salvage “end stage” failed TT amputations served the purposes of maintaining knee extension during the healing period, allowing closure & healing of threatened and/or dehisced flaps and maintaining knee function. Motivated, compliant patients with failed, otherwise considered non salvageable TT amputations should be considered for using our protocol in deference to proceeding to an AKA.

An Interdisciplinary Perioperative Management Protocol for Patients with Sickle Cell Anemia: A Single-Surgeon Experience

2018 ◽  
Vol 84 (6) ◽  
pp. 1120-1122
Author(s):  
Sara Scarlet ◽  
Raeshell S. Sweeting ◽  
Kenneth I. Ataga ◽  
Rupa C. Redding-Lallinger ◽  
Antony A. Meyer
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Perioperative Management ◽  
Management Protocol ◽  
Surgeon Experience

scholarly journals Should heart failure patients be left to fate? Temporary implementation of veno-arterial extracorporeal membrane oxygenation for haemodynamic support during excision of rectal carcinoma in an end-stage biventricular heart failure patient

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878921
Author(s):  
Vera Hergesell ◽  
Erwin Mathew ◽  
Peter Kornprat ◽  
Igor Knez ◽  
Hans-Joerg Mischinger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Rectal Carcinoma ◽  
Heart Failure Patient ◽  
Perioperative Management ◽  
Perioperative Morbidity ◽  
Heart Failure Patients ◽  
Membrane Oxygenation ◽  
End Stage Heart Failure ◽  
End Stage

Management of end-stage heart failure patients requiring major general surgery is not well defined. Due to poor cardiorespiratory reserve, perioperative morbidity and mortality are excessively high. We report a case of temporary implementation of veno-arterial extracorporeal membrane oxygenation for haemodynamic support during excision of rectal carcinoma in an end-stage heart failure patient and describe perioperative management.

Day-case laparoscopic cholecystectomy: analysis of the factors allowing early discharge

2017 ◽  
Vol 69 (4) ◽  
pp. 461-469 ◽  
Author(s):  
Giovanni Domenico Tebala ◽  
Angela Belvedere ◽  
Sean Keane ◽  
Abdul Qayyum Khan ◽  
Abdelsalam Osman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Early Discharge ◽  
Day Case
Sign in / Sign up

Export Citation Format

Share Document