Abstract
The aim of this study is to evaluate the additional costs associated with calcium monitoring and treatment as well as evaluate the incidence and predictors of postthyroidectomy hypocalcemia. Methods. This case-control study involved thyroidectomy and completion thyroidectomy patients operated on between January 2012 and August 2013. Cases were defined as requiring calcitriol supplementation, and controls did not require supplementation. Patient (age, sex), nodule (cytology, pathology), surgical data (neck dissection, parathyroid identification, and reimplantation), and hospital stay (days hospitalized in total and after drain removal) were compared. Comparisons were made using t-tests and chi-square tests with an alpha of 0.05. The estimated cost associated with the extended stay was then compared with the cost of supplementation. Results. A total of 191 patients were evaluated (61 cases and 130 controls). Predictors of hypocalcemia include female age, neck dissection, and parathyroid reimplantation. Hypocalcemic patients were hospitalized for a longer period of time after drain removal (2.5 versus 0.8 days, P<0.001), and hospitalization costs after neck drain removal were higher in this group as well (8,367.32$ versus 2,534.32$, P<0.001). Conclusion. Postoperative hypocalcemia incurs significant additional health care costs at both the local and health care system levels.
Highlights
As thyroid cancer has the most rapidly rising incidence rate of all major cancers in Canada [1], surgeons will likely be performing an increasing number of thyroidectomies in the foreseeable future
One of the major complications following completion and total thyroidectomy is postoperative hypocalcemia [2], which is mainly due to hypoparathyroidism when the parathyroid glands are put at risk of devascularization, with incidence rates of up to 33% being reported in centers where it is managed only on the basis of clinical observation and calcium monitoring [3]
Hypocalcemic patients were hospitalized for a longer period of time after drain removal (2.5 versus 0.8 days, P < 0.001), and hospitalization costs per patient after neck drain removal were higher in this group as well (8,367.35$ versus 2,534.33$, P < 0.001)
Summary
As thyroid cancer has the most rapidly rising incidence rate of all major cancers in Canada [1], surgeons will likely be performing an increasing number of thyroidectomies in the foreseeable future. One of the major complications following completion and total thyroidectomy is postoperative hypocalcemia [2], which is mainly due to hypoparathyroidism when the parathyroid glands are put at risk of devascularization, with incidence rates of up to 33% being reported in centers where it is managed only on the basis of clinical observation and calcium monitoring [3]. Some research has focused on developing protocols and guidelines to reduce the incidence of postoperative hypocalcemia [4,5,6], there is very little data on the economic impact of the monitoring and treatment of postthyroidectomy hypocalcemia in Canada. The aim of this study is to evaluate the incidence and the predictors of postoperative hypocalcemia following thyroid surgery as well as to evaluate the additional cost of prolonged hospitalization incurred by the surveillance and treatment of hypocalcemia
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