Safety, Efficacy, and Cost Savings of Single Parathyroid Hormone Measurement for Risk Stratification after Total Thyroidectomy

2013 ◽  
Vol 79 (8) ◽  
pp. 768-774 ◽  
Author(s):  
Meghan McCullough ◽  
Collin Weber ◽  
Chris Leong ◽  
Jyotirmay Sharma
Keyword(s):  
Parathyroid Hormone ◽  
Risk Stratification ◽  
Total Thyroidectomy ◽  
Calcium Supplementation ◽  
Cost Savings ◽  
Day Surgery ◽  
Laboratory Cost ◽  
Number Of Patients ◽  
Same Day Discharge ◽  
Hospital Stays

The management of hypocalcemia (HC) after total thyroidectomy (TTx) is a challenge as TTx is transitioned into a same-day surgery. Measurement of parathyroid hormone (PTH) level after TTx may allow for prediction of postoperative HC and lead to shorter hospital stays. A prospective database was queried between January 2010 and June 2012 with 95 patients who had undergone TTx identified. Patient demographics; preoperative diagnosis; laboratory values and cost; complications; intravenous calcium supplementation; and length of stay (LOS) were analyzed. A PTH-based algorithm was retrospectively applied and theoretical cost savings were analyzed in terms of laboratory cost, LOS, and total cost. Ninety-five patients underwent TTx: 37 patients (38.9%) had cancer, whereas 27 (28.4%) had Graves’ disease and the remaining 31 (32.6%) had a benign multinodular goiter. Postoperative PTH was recorded in 72 patients (74.4%); 46 (63.8%) had PTH greater than 10 pg/mL and 26 (36.9%) had PTH less than 10 pg/mL. Transient HC occurred in 10 patients (38.4%) with PTH less than 10 pg/mL (relative risk, 17.69; P = 0.0001). Patients with PTH less than 10 pg/mL incurred a 14.9 per cent higher hospital cost compared with those with PTH greater than 10 pg/mL. With retrospective implementation of the algorithm, there is a potential 46.4 per cent cost savings for the PTH less than 10 pg/mL group, 67.3 per cent savings for the PTH greater than 10 pg/mL group, and 46.7 per cent savings when taken altogether. Algorithmic risk stratification based on postoperative PTH less than 10 pg/mL serves as both a sensitive (100%) and specific (76.7%) predictor of postoperative HC. Such risk stratification may allow for same-day discharge in a number of patients, and even in patients requiring an overnight stay, result in cost savings as a result of a reduction in laboratory expenditures.

Benefits Resulting from 1-and 6-Hour Parathyroid Hormone and Calcium Levels After Thyroidectomy

2005 ◽  
Vol 133 (3) ◽  
pp. 386-390 ◽  
Author(s):  
Richard J. Payne ◽  
Marc A. Tewfik ◽  
Michael P. Hier ◽  
Michael Tamilia ◽  
Elizabeth Mac Namara ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Critical Level ◽  
Cost Savings ◽  
Vitamin D Supplementation ◽  
Experimental Protocol ◽  
Blood Tests ◽  
Hospital Stays ◽  
A Prospective Study ◽  
The Impact

OBJECTIVE: Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post-thyroidectomy without compromising safety. STUDY DESIGN AND SETTING: This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6-hour critical level of PTH ≥ 28 ng/L and simultaneous corrected calcium ≥ 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1-hour PTH levels ≤ 8 ng/L were prophylactically treated with calcium and vitamin D supplementation. RESULTS: This study demonstrates lower rates of transient hypocalcemia from 28% to 9% (OR = 4.13, P = 0.016), a 10-hour reduction in mean hospital stay, and fewer blood tests (23 vs 15) for patients undergoing total thyroidectomy since the implementation of the new protocol. Furthermore, the experimental protocol resulted in an average cost savings of $766 per patient. CONCLUSIONS: The new algorithm resulting from PTH and corrected calcium monitoring at 1 and 6 hours post-thyroidectomy has led to significant cost savings for our institution. It has also translated into greater patient satisfaction as a result of fewer blood tests, a lower incidence of transient hypocalcemia, and significantly shorter hospital stays.

Abstract P65: Outpatient Atrial Fibrillation Ablation on Therapeutic Warfarin - Safety, Efficacy, and Cost Savings

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Michael C Giudici ◽  
Deborah L Paul ◽  
Caroline Sloane ◽  
Gisela Press ◽  
Ashley Petersen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Savings ◽  
Nerve Paralysis ◽  
Phrenic Nerve Paralysis ◽  
Outpatient Unit ◽  
Heparin Administration ◽  
Same Day Discharge ◽  
Procedural Time ◽  
Hospital Stays ◽  
Mean Time

Introduction: Catheter ablation for atrial fibrillation (PVI) is being performed with increasing frequency. This time and labor-intensive procedure is under increasing scrutiny as we look for means to decrease costs of delivering care. Performing these procedures on therapeutic warfarin could shorten hospital stays, eliminate costly low-molecular weight heparin (LMW) use, and decrease procedural heparin administration which could reduce hemorrhage from access sites. Methods: Over a six-year period, 180 patients, 138 M/42 F, mean age 43 yr (18-77 yr), underwent PVI for persistent - 99 pts., and paroxysmal - 81 pts. atrial fibrillation. Mean INR was 2.2 (1.5 - 4.2). Procedures were performed with standard radiofrequency (RF) catheters - 132, Cryoablation - 27, and Ablation Frontiers RF - 21. Procedural time, fluoroscopy time, hospital stays, outcomes, and complications were tracked. Results: 127 of 180 pts. were discharged the day of procedure (OP) from the outpatient unit, 51 pts. stayed one night post-procedure (IP), 2 patients stayed 4 days, one for pulmonary treatment and one for CVA. Mean procedural length was 3.3 hours, mean fluoro time was 52 min. Mean time from hospital admit to discharge was 17.3 hr. Mean time from procedure end to discharge was 11.0 hr. 77% of pts. were free from AF on follow-up on no meds or “pill-in-the-pocket”. 6 complications occurred - 1 phrenic nerve paralysis (resolved), 2 CVAs (one was 72 hrs post PVI), 1 perforation/tamponade, 1 groin bleed requiring evacuation, 1 PV stenosis. There was no difference in outcome for patients discharged OP vs IP. Cost savings by continuing warfarin were LMW = $205/dose X 6 doses - $1230/pt. Cost savings by same day discharge = $1330/day. Conclusions: PVI can be safely performed as an outpatient procedure on therapeutic warfarin with good clinical outcomes. Significant cost savings can be realized from OP PVI from reduced staff, medication, and facilities utilization.

scholarly journals Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

2016 ◽  
Vol 8 (3) ◽  
pp. 203-207 ◽  
Author(s):  
MJ Paul ◽  
Thomas V Paul ◽  
Deepak T Abraham ◽  
Anish Cherian
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Calcium Supplementation ◽  
Early Discharge ◽  
Tertiary Hospital ◽  
Vitamin D Supplementation ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Dysfunction ◽  
Pth Level

ABSTRACT Aims Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution's postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients. Materials and methods A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1. Results A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium <8 mg/dL). Postoperative PTH was low (<8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH < 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of <6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively. Conclusion The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH <6 pg/mL can be used as our institution's cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients. Clinical significance Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients. How to cite this article Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

Same-day discharge after total thyroidectomy: The value of 6-hour serum parathyroid hormone and calcium levels

Head & Neck ◽  
2004 ◽  
Vol 27 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Richard J. Payne ◽  
Michael P. Hier ◽  
Michael Tamilia ◽  
Elizabeth Mac Namara ◽  
Jonathan Young ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Parathyroid Hormone ◽  
Same Day Discharge

Same-day Discharge after Appendectomy Results in Cost Savings and Improved Efficiency

2014 ◽  
Vol 80 (8) ◽  
pp. 787-791 ◽  
Author(s):  
Sandra M. Farach ◽  
Paul D. Danielson ◽  
N. Elizabeth Walford ◽  
Richard P. Harmel ◽  
Nicole M. Chandler
Keyword(s):  
Hospital Costs ◽  
Cost Savings ◽  
Day Surgery ◽  
Hospital Charges ◽  
Patient Transfers ◽  
Same Day Discharge ◽  
Hospital Resources ◽  
The Mean ◽  
Clinical Measures ◽  
Cent Patient

Appendectomy incurs significant costs for the healthcare system. There is evidence that patients can be safely discharged the same day after appendectomy. The purpose of this study was to develop an evidence-based protocol for same-day discharge after appendectomy. A fast-track surgery protocol was developed for same-day discharge after appendectomy. This was prospectively applied to all patients presenting for appendectomy from July 2012 to June 2013. Demographics, clinical measures, and outcomes were measured. Of 206 patients eligible for same-day discharge, 185 (90%) were successfully discharged according to the protocol. The mean length of stay after appendectomy was 3.1 ± 1.4 hours. Protocol implementation reduced inpatient use from 99 to 53 per cent. Patient transfers were reduced, resulting in 40 per cent fewer handoffs. The decreased use of hospital resources resulted in a median reduction of hospital charges of $4111 per patient. The complication rate for patients discharged the same day was 2.7 per cent. Appendectomy for acute appendicitis or interval appendectomy can be performed safely as same-day surgery. Implementation of this protocol resulted in optimization of resource use by reducing inpatient admissions, decreasing handoffs, and reducing hospital costs.

scholarly journals Parathyroid hormone assay following total thyroidectomy for early prediction of post-operative hypocalcemia

2018 ◽  
Vol 5 (3) ◽  
pp. 1100
Author(s):  
Naveen Arnepalli ◽  
Chethan Kishanchand ◽  
Balaji Jayasankar
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Hormone Level ◽  
Calcium Supplementation ◽  
Definitive Treatment ◽  
Early Prediction ◽  
Parathyroid Hormone Level ◽  
Hormone Levels ◽  
Parathyroid Hormone Assay ◽  
Hormone Assay

Background: Detecting post-operative hypocalcaemia following total thyroidectomy using serum parathyroid hormone levels would help in an earlier and a definitive treatment plan in treating hypocalcaemia.Methods: This was a prospective interventional study done in a tertiary care teaching hospital. This was mainly done to assess the post-operative hypocalcemia following total thyroidectomy using parathyroid hormone levels and to assess the correlation between the two. With a baseline levels recorded patients underwent a post-operative evaluation of parathyroid hormone 1 hour after total thyroidectomy and serum calcium levels on day 1, 2, 3 and 4 after surgery. The same was statically analyzed to find a correlation between parathyroid hormone levels and the degree of hypocalcemia and evaluated to see if parathyroid hormone was a reliable clinical indicator.Results: A total of 43 patients were included in the study and the parathyroid hormone levels were assessed following surgery, the same was plotted statistically. Sensitivity of parathyroid hormone drop by 75% in predicting hypocalcaemia was 95%. 50% drop in parathyroid hormone levels was a sensitive predictor of hypocalcaemia. A PTH value of less than 15.1pg/ml was highly specific and sensitive indicator of hypocalcaemia.Conclusions: Parathyroid hormone Assay following total thyroidectomy is reliable for early prediction of hypocalcaemia. Patients with a parathyroid hormone level <9pg/ml or with 75% drop in parathyroid hormone level are at a high risk for hypocalcaemia and would require calcium supplementation.

scholarly journals Evaluation of the Performance and Clinical Impact of a Rapid Intraoperative Parathyroid Hormone Assay in Conjunction with Preoperative Imaging and Concise Parathyroidectomy

2001 ◽  
Vol 47 (5) ◽  
pp. 919-925 ◽  
Author(s):  
Lawrence R Johnson ◽  
Gerard Doherty ◽  
Terry Lairmore ◽  
Jeffrey F Moley ◽  
L Michael Brunt ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
New Technologies ◽  
Frozen Section ◽  
Preoperative Imaging ◽  
Control Group ◽  
Frozen Sections ◽  
Laboratory Cost ◽  
Intraoperative Pth ◽  
Hospital Stays ◽  
99Mtc Sestamibi

Abstract Background: 99mTc-sestamibi scans and rapid, intraoperative intact parathyroid hormone (PTH) assays allow preoperative identification of diseased glands and intraoperative confirmation of diseased gland removal, respectively. Use of these two new technologies may facilitate simpler, more concise surgery, shorter hospital stays, and decreased costs for frozen-section analysis. One major drawback to this new strategy has been the high cost of rapid point-of-care PTH assays. Methods: We performed rapid PTH assays with the DPC Turbo PTH assay on the DPC IMMULITE automated analyzer. The number of intraoperative frozen sections, type of anesthesia, surgical approach, length of hospital stay, and pre- and postoperative calcium values were compared between a group of 49 patients undergoing parathyroidectomy where the intraoperative PTH assay was used in conjunction with preoperative imaging, and a historical control group of 55 patients before the use of these two technologies in our institution. Results: Comparison of the Turbo PTH assay to the standard IMMULITE PTH assay gave the following: y = 1.08x − 4.36 (r = 0.97; n = 48). For the 49 patients, the median turnaround time for each intraoperative PTH determination was 19 min (range, 14–40 min). The median decrease in PTH values from baseline was 88% (range, 33–99%). Thirty-seven patients required two PTH determinations, 7 required three, 4 had four, and 1 required five determinations. The average laboratory cost for the rapid intraoperative PTH assays was &lt;$100 per patient (range, $55 to $113). Compared with the control group, the experimental group had significantly fewer frozen sections (1.4 vs 2.5; P &lt;0.0001), shorter hospital stays (17 discharged on the day of surgery vs none discharged on the day of surgery; P &lt;0.0001), greater use of local anesthesia (33% vs 0%; P &lt;0.001), and more unilateral, rather than bilateral neck explorations (65% vs 0%; P &lt;0.001). Conclusions: The combination of intraoperative Turbo PTH assay and preoperative 99mTc-sestamibi scans can lead to significant decreases in laboratory and surgical pathology costs, hospital stays, and exposure to general anesthesia by facilitating concise parathyroidectomy surgery.

Introducing day case thyroid lobectomy at a tertiary head and neck centre

2021 ◽  
Vol 103 (7) ◽  
pp. 499-503
Author(s):  
Z Sheikh ◽  
V Lingamanaicker ◽  
E Irune ◽  
B Fish ◽  
P Jani
Keyword(s):  
Cost Effective ◽  
Day Surgery ◽  
British Association ◽  
Day Case ◽  
Thyroid Lobectomy ◽  
Number Of Patients ◽  
Same Day Discharge ◽  
Postoperative Haematoma ◽  
The Uk ◽  
Disseminated Disease

Background Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. Methods We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery’s 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. Results In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. Conclusions Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

scholarly journals A prospective study on parathyroid hormone levels in detecting early hypocalcemia after total thyroidectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3242
Author(s):  
Sunil Kumar A. P. V. ◽  
Vinay G.
Keyword(s):  
Parathyroid Hormone ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
Calcium Supplementation ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Early Discharge ◽  
Hormone Deficiency ◽  
Hormone Levels ◽  
A Prospective Study

Background: Hypoparathyroidism and the resultant hypocalcaemia is a major cause of postoperative morbidity after total thyroidectomy with the incidence varying from 1% to 71%. This study aims to determine the incidence of parathyroid hormone deficiency as an earliest indicator for detecting hypocalcemia following total thyroidectomy.Methods: A prospective study was carried out among 50 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 12 months. Subjects of either sex undergoing total thyroidectomy had their serum parathyroid hormone levels tested at 1, 4, 12 and 24 hours after surgery were included in the study. Patients with poor compliance, calcium supplementation prior to surgery, coexisting parathyroid or renal pathology were excluded from the study. Descriptive statistics and Pearson correlation coefficients were used to analyse the results.Results: Among 50 study subjects, Hypocalcemia developed in 3 subjects (6%) 24 hours after thyroidectomy showing a sensitivity, specificity, negative and positive predictive value of 91%, 100%, 98% and 96% respectively.Conclusions: Parathyroid hormone levels in postoperative total thyroidectomy is an earliest indicator to detect symptomatic hypocalcemia subjects 24 hours after surgery, which prompts early administration of oral calcium replacement therapy in high risk subjects and potential safe early discharge post-operatively.

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