Cost Analysis of Postthyroidectomy Hypocalcemia

Abstract

Objective: One of the more common complications following total thyroidectomy is postoperative hypocalcemia. Numerous protocols have been developed over the years for management including perioperative parathyroid hormone (POPTH) levels and obtaining ionized calcium levels postoperatively with supplementation based on the values. Our goal was to perform a cost analysis of POPTH. Method: We examined the postoperative hypocalcemia using ICD-9 codes for thyroid nodules and examined those that underwent total thyroidectomy. We excluded revision surgeries and pathology of cancer. The postoperative PTH values, initial ionized calcium, and number of calcium draws were obtained. The patients were then stratified based on initial PTH value. Results: For initial PTH For initial PTH 21-50, the initial ionized calcium was 3.99 ± 0.38 and the number of laboratory draws was 3.8 ± 3.3. For initial PTH >50, the initial ionized calcium was 4.27 ± 0.37 and the number of laboratory draws was 2.5 ± 1.7. There was no significant difference in the initial ionized calcium between those that had an initial PTH drawn and those that did not. Conclusion: For total thyroidectomies (benign goiter), there was no difference in the initial ionized calcium for PTH90 ( P = .29). This suggests that PTH is not an adequate predictor of postoperative calcium level. Also there is a significant cost burden with obtaining the PTH level where tremendous savings could be achieved.