Preoperative Serum Calcium Levels Research Articles

PREVALENCE AND PATHOPHYSIOLOGY OF POST-THYROIDECTOMY HYPOCALCAEMIA

Post-thyroidectomy hypocalcemia is a recognised and potentially significant complication arising from the surgical removal of the thyroid gland. The study's main objective is to find the prevalence and pathophysiology of post-thyroidectomy hypocalcemia. This prospective observational study was conducted in Civil Hospital Quetta from June 2021 to July 2022. A total of 162 patients undergoing thyroidectomy for various indications, including thyroid cancer, hyperthyroidism, and goiter, were enrolled in the study. Before surgery, baseline data were gathered, including demographic information, medical history, and preoperative serum calcium and parathyroid hormone (PTH) levels, from the 162 enrolled patients scheduled for thyroidectomy. Data were collected from 162 patients from both genders. The mean age of patients was 48.5 ± 8.2 years, with 70% female. The diagnoses included 40% with thyroid cancer, 30% with hyperthyroidism, and 30% with a large goiter. Preoperative serum calcium levels were 9.0 ± 0.5 mg/dL, parathyroid hormone (PTH) levels were 45 ± 9.80 pg/mL, and vitamin D levels were 25.5 ± 6.3 ng/mL. A history of hypocalcemia was noted in 5% of the participants. The mean serum calcium level was 9.0 mg/dL, with a standard deviation of 0.5. However, at 48 hours post-op, there was a decrease in the mean serum calcium level to 7.8 mg/dL, with a standard deviation of 0.7. It is concluded that the interaction between reduced serum calcium and parathyroid hormone levels highlights the immediate impact of surgery on calcium homeostasis.

Factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients.

Parathyroidectomy (PTX) is an effective treatment for primary hyperparathyroidism (PHPT) patients. Postoperative hypocalcemia is a common complication after PTX. This study aimed to analyze the factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients. The retrospective study included 270 PHPT patients treated with PTX and collected their demographic and clinical information and their laboratory indices. Factors influencing serum calcium levels and hypocalcemia after PTX in PHPT patients were analyzed using univariate and multifactorial analyses. First, in patients with normal preoperative serum calcium levels (2.20-2.74 mmol/L), the higher the preoperative alkaline phosphatase and serum phosphorus levels, the lower the postoperative serum calcium levels. Furthermore, the higher the preoperative serum calcium levels and the accompanying clinical symptoms, the higher the postoperative serum calcium levels. Low preoperative serum calcium levels were shown to be a risk factor for postoperative hypocalcemia (OR=0.022), and the optimal preoperative serum calcium threshold was 2.625 mmol/L (sensitivity and specificity were 0.587 and 0.712, respectively). Second, in the mild preoperative hypercalcemia group (2.75-3.00 mmol/L), the older the patient, the higher the preoperative and postoperative serum calcium levels, the higher the postoperative serum calcium; the lower the alkaline phosphatase and calcitonin levels, the higher the postoperative serum calcium levels. On the other hand, the younger the patient was, the more likely hypocalcemia blood was (OR=0.947), with an optimal age threshold of 47.5 years (sensitivity and specificity were 0.543 and 0.754, respectively). Third, in the preoperative moderate to severe hypercalcemia group (>3.0mmol/L), patients undergoing a combined contralateral thyroidectomy and a total thyroidectomy had low postoperative serum calcium levels. Patients with different preoperative serum calcium levels had various factors influencing their postoperative serum calcium levels and postoperative hypocalcemia, which facilitated the assessment of their prognosis.

Surgical management of neonatal severe hyperparathyroidism.

Neonatal severe hyperparathyroidism (NSHPT) is a rare disease that can be lethal. Most patients require parathyroidectomy. Report experience in managing this severe disease. Retrospective chart review of case series. Tertiary health care center. We reviewed data on patients managed for NSHPT from June 2001 to January 2023. Demographic, clinical, and follow-up data were collected, and descriptive data were generated. Pre- and postoperative levels of parathyroid hormone (PTH) and serum calcium, and effect of autotransplantation. 19 RESULTS: The 13 males and 6 females had a a mean age of 46 days at referral. The mean preoperative parathyroid hormone (PTH) and serum calcium levels were 996 ng/L and 4.54 mmol/L, respectively. Twelve patients underwent ultrasonography preoperatively. Of these, six had prominent glands, while no glands were seen in the other six. A Sestamibi scan was done for 15 patients, of which nine showed negative results and six showed positive results, with three glands observed in the neck and three in the sublingual area. Nineteen patients underwent renal ultrasonography, with nine showing nephrocalcinosis. The mean age at surgery was 5.2 months. Total parathyroidectomy (four glands) was performed in 17 patients, and 15 underwent concurrent auto-transplantation. One patient had three glands removed, in addition to auto-transplantation. Another underwent single gland excision as a redo-surgery after previous surgery elsewhere. The mean postoperative follow-up duration was 6 years. The mean postoperative PTH and calcium levels were 25 ng/L and 1.64 mmol/L, respectively. Ultimately, all the patients were required to initiate calcium and vitamin D supplements, except for two patients who had undergone auto-transplantation. Molecular genetic screening of the calcium-sensing receptor gene reported likely pathogenic/pathogenic mutations in 16 of 19 patients (13 were homozygous, two were heterozygous, one was negative, and data was unavailable for the remaining three patients). Surgical treatment of NSHPT is effective. Preoperative radiological localization studies did not impact the treatment plan. Auto-transplantation proved ineffective in maintaining independence from medical supplements. The retrospective nature of the study may imply inaccuracybut since the data are gathered from electronic medical records, we believe it is highly accurate. The small sample size limits generalizability.

Preoperative Serum Calcium Level Predicts Postoperative Mortality in Older Adult Patients with Hip Fracture: A Prospective Cohort Study of 2333 Patients

ObjectivesHip fractures are a significant cause of mortality among older adults. However, predictive markers for an unfavorable prognosis are still lacking. Serum calcium is an essential element in several biochemical reactions in the body. This study investigated the role of the preoperative serum calcium level as a prognostic parameter for postoperative mortality in older adult patients with hip fractures. DesignWe conducted a prospective cohort study at the trauma center in our hospital, from January 1, 2015, to September 30, 2019. A total of 2333 older patients with hip fractures were recruited. This prospective cohort study was conducted in accordance with the criteria of STROCSS. Setting and ParticipantsOlder adult patients with hip fractures were screened between January 2015 and September 2019 at the trauma center of our hospital. MethodsDemographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between preoperative serum calcium level and all-cause mortality. All analyses were performed using EmpowerStats and the R software. ResultsA total of 2333 older adult patients with hip fractures were included in the study. The mean follow-up was 37.5 months. Overall, 770 patients (33%) died of all causes. The preoperative serum calcium concentrations were 2.18 ± 0.13 mmol/L. Linear multivariate Cox regression models showed that preoperative serum calcium levels were associated with mortality [hazard ratio (HR) 0.37, 95% CI 0.21-0.67; P = .0009] after adjusting for confounders. However, the linear association was unstable, and nonlinearity was identified. A preoperative serum calcium level of 2.3 mmol/L was an inflection point for prediction. When the preoperative serum calcium concentration was below 2.3 mmol/L, serum calcium concentration increased by 1 mmol/L, and mortality risk decreased by 77% (HR 0.23, 95% CI 0.13-0.43, P < .0001). In contrast, when the preoperative serum calcium concentration was more significant than 2.3 mmol/L, the mortality risk increased with serum calcium concentration (HR 6.27, 95% CI 1.65-23.74, P = .0069). Conclusions and ImplicationsThe preoperative serum calcium level is nonlinearly associated with mortality in older adults with hip fractures, with a U-shaped association, and could be used as a potential predictor of prognosis.

Hungry bone syndrome in peritoneal dialysis patients after parathyroid surgery.

Secondary hyperparathyroidism (SHPT) is a common complication of end-stage kidney disease (ESKD). Hungry bone syndrome (HBS) occurs frequently in patients on maintenance dialysis receiving parathyroidectomy for refractory SHPT. However, there is scanty study investigating the clinical risk factors that predict postoperative HBS, and its outcome in peritoneal dialysis (PD) patients. We conducted a single-center retrospective study to analyze 66 PD patients who had underwent parathyroidectomy for secondary hyperparathyroidism at Chang Gung Memorial Hospital between 2009 and 2019. The patients were stratified into two groups based on the presence (n=47) or absence (n=19) of HBS after parathyroidectomy. Subtotal parathyroidectomy was the most common surgery performed (74.2%), followed by total parathyroidectomy with autoimplantation (25.8%). Pathological examination of all surgical specimens revealed parathyroid hyperplasia (100%). Patients with HBS had lower levels of postoperative nadir corrected calcium, higher alkaline phosphate (ALP), and higher potassium levels compared with patients without HBS (all P<0.05). A multivariate logistic regression model confirmed that lower preoperative serum calcium level (OR 0.354, 95% CI 0.133-0.940, P=0.037), higher ALP (OR 1.026, 95% CI 1.008-1.044, P=0.004), and higher potassium level (OR 6.894, 95% CI 1.806-26.317, P=0.005) were associated with HBS after parathyroidectomy. Patients were followed for 58.2±30.8 months after the surgery. There was no significant difference between HBS and non-HBS groups in persistence (P=0.496) or recurrence (P=1.000) of hyperparathyroidism. The overall mortality rate was 10.6% with no significant difference found between both groups (P=0.099). We concluded that HBS is a common complication (71.2%) of parathyroidectomy for SHPT and should be managed appropriately.

Comparison of frequency of Hypoparathyroidism in Total Thyroidectomy (TT) versus Near-Total Thyroidectomy (NTT) patients

BACKGROUND &amp; OBJECTIVE: Hypoparathyroidism in total thyroidectomy and near-total thyroidectomy is debatable. This study will determine the procedure of choice. Our objective is to compare the frequency of hypoparathyroidism in total thyroidectomy versus near-total thyroidectomy patients.&#x0D; METHODOLOGY: Prospective observational study was conducted at the Department of Surgery, Allied Hospital, Faisalabad. The study duration was six months. A total of 140 patients having multinodular goiter, 30-70 years of age, were selected. Patients were divided into two groups. In group A; patients underwent total thyroidectomy while in group B; patients were offered near-total thyroidectomy. All the parathyroid glands were preserved. In all patients, serum calcium levels and parathyroid hormone (PTH) levels were checked on 1st &amp; the 2nd day after surgery.&#x0D; RESULTS: Mean age in group A was 48.06±8.21 years &amp; in group B was 48.83 ± 7.0 years. The majority of patients, 88 (62.86%) were between 30 to 50 years of age. Out of these 140 patients, 37 (26.43%) were males &amp; 103 (73.57%) were females, with the ratio of 1:2.8. Mean pre-operative serum Parathyroid hormone was 25.67±9.87 pg/mL. The mean postoperative serum Parathyroid hormone was 16.87±2.43 pg/mL. Mean pre-operative serum calcium levels were 11.32 ± 4.52 mg/dl and mean postoperative serum calcium levels were 9.4 ±0.45mg/dl. In this study, the frequency of Hypoparathyroidism in the total thyroidectomy group (28.57%) was significantly higher than near-total thyroidectomy (8.57%) (p=0.002).&#x0D; CONCLUSION: Hypoparathyroidism is more common after total thyroidectomy as compared to near-total thyroidectomy.

Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience.

The aim of our study is to assess the feasibility, safety and adequacy of focused parathyroidectomy for single parathyroid adenoma accurately localized preoperatively by ultrasound neck and Tc99m sestamibi scan. The study was conducted in the department of Otorhinolaryngology of SMS Medical College and Hospital, Jaipur on 116 patients of primary hyperparathyroidism who underwent minimally invasive parathyroidectomy (MIP) for single gland adenoma localized by USG neck and tc99m sestamibi scans. S. Calcium and S. PTH followed up on day 1, 6th week and 6th month. Outcomes were determined on the basis of cure rate, duration of hospitalization, complication rates and disease persistence/recurrence rate. 82 (70.68%) females and 34 (29.31%) males belonging to the age group of 21-67years (43.02 ± 14) formed the basis of our study. Skeletal (73.27%) and renal (62.93%) were the most common presentations. Accuracy of USG and sestamibi accurately was 93.10% and 96.55% respectively with combined accuracy of 100%. Preoperative serum calcium levels of 10.7-16.03mg/dl (13.09 ± 2.11) and serum PTH 127-2196pg/ml (846.57 ± 776.55) were observed. Cure rate of MIP was 99.13%. No permanent complications seen. MIP can be used as the surgical procedure of choice for PHPT caused by single gland adenoma aided by USG and sestamibi scan. The cure rates are equivalent to the bilateral neck exploration (> 95%) with minimal morbidity and complications. Hence, it is a more feasible, safe and effective treatment option.

Differences in the Clinical Presentation and Biochemical Profile of the Patients with Primary Hyperparathyroidism with regard to their Serum Vitamin D Levels: a Single-center Experience.

The association between vitamin D deficiency and primary hyperparathyroidism (PHPT) is common and has clear implications. Vitamin D deficiency is commonly seen in PHPT population and exacerbates its severity with skeletal and metabolic effects. Retrospective data collection and review were done in patients who underwent surgery for PHPT at a tertiary care hospital in India between January 2011 and December 2020. A total of 150 subjects were included in the study and were divided into group 1 (vitamin D < 20ng/ml, deficient), group 2 (vitamin D 21-29ng/ml, insufficient), and group 3 (vitamin D > 30ng/ml, sufficient). There was no difference in the duration of symptoms or the symptomatology between the three groups. Mean pre-operative serum calcium and serum phosphorous levels were also comparable in all the three groups. Mean pre-operative parathyroid hormone (PTH) levels in the three groups were 703 ± 996 vs 343.6 ± 396 vs 343.6 ± 396pg/ml, respectively (P = 0.009). There was a statistically significant difference in group 1 vs groups 2 and 3 in their mean weight of the parathyroid gland (P = 0.018) and high alkaline phosphatase (ALP) levels (P = 0.047). Post-operative symptomatic hypocalcemia was observed in 17.3% of patients. Post-operative hungry bone syndrome occurred in 4 patients, all in group 1. PHPT in patients with low serum vitamin D was associated with higher serum PTH levels, increased frequency of high serum ALP levels, and higher weight of the excised gland, with no difference in the serum calcium and phosphorous.

HYPOCALCEMIA AND HYPOPARATHYROIDISM AFTER NEAR TOTAL THYROIDECTOMY:

Background : Post-operative hypocalcemia is a common and usually a transient event after thyroidectomy due to iatrogenic injury to the parathyroid glands. Most of the studies had investigated the frequency of surgical complications in Total thyroidectomy patients. Unfortunately, very few studies had investigated about the hypocalcemia and hypoparathyroidism frequency in near total thyroidectomy patients post-surgically Aims: . We carried out this study to evaluate the hypothyroidism and hypoparathyroidism frequency in thyroid disorder patients who underwent near total thyroidectomy. Methods: We performed a retrospective analysis of 202 patients who underwent near-total thyroidectomy at our institution from May 2017 to April 2022. Institutional Ethical committee approval was taken and Waiver of consent was taken from the head of the surgery department before the data collection. Post near-thyroidectomy patients who were above 18 years old with normal preoperative serum calcium levels (i.e., 8.4-10.2µL) were included. The patients who underwent subtotal thyroidectomy, thyroidectomy with neck dissection, hemi-thyroidectomy, concurrent lymph nodes dissection, complete thyroidectomy following hemi-thyroidectomy, parathyroid auto transplantation and those who received calcium supplementation before surgery were excluded from the study. Therefore, medical records of 478 patients were reviewed and nally 202 patients were included in the study who fullled both the inclusion and exclusion criteria. Conclusion: The results obtained conrm that transient hypocalcemia can be observed after any operation; and particularly responsible is the decrease of the calcium concerning the proteins. We found that post-operative hypoparathyroidism is due to injury to the parathyroid glands (parathyroid ischaemia or surgical ablation of one or more glands). Here we see the delayed serum calcium level &lt; or = 7.5 mg/dl or the delayed serum phosphorous level &gt; 7.4 mg/dl. The results of our study, with 2 patients presenting transient post-operative hypoparathyroidism, contribute in conrming that the extracapsular total thyroidectomy aimed to reduce any injury to the parathyroid and to the recurrent nerves, represent the better operation also for the extended benignant thyroidopathies.

Preoperative serum calcium could be a prognostic factor for surgical treatment of recurrent patellar dislocation: a retrospective study

BackgroundSurgical treatment for recurrent patellar dislocation (RPD) could yield good outcomes. While, unsatisfactory recovery still exists in some cases. For all prognostic factors, serum biomarkers have rarely been investigated. This study aimed to evaluate the prognostic value of preoperative serum calcium level, a widely used serum biomarker, in surgical treatment for RPD.Study designRetrospective study.MethodsNinety-nine patients with RPD were enrolled in the study. Preoperative serum calcium was acquired from routinely tested blood 1 day prior to operation. Demographic data, characteristics of RPD, postoperative functional outcomes were obtained. The association between preoperative calcium and postoperative functional outcomes (Kujala, Lysholm, Tegner, IKDC and KOOS score) was determined by correlation analysis and multivariate linear regression analysis. Poor recovery was determined as Kujala score below 80. The receiver operating characteristic (ROC) curve was used to assess the prognostic value of preoperative calcium.ResultsPatients were followed up for a mean period of 2.45 ± 1.33 years. All clinical scores showed significant improvement at the latest follow-up. Correlation and multivariate linear analyses indicated that serum calcium level was an important factor related with the prognosis of surgical treatment for RPD. According to the ROC curve, the cut-off value for preoperative calcium was 2.225 mmol/L. The clinical outcomes of patients with a preoperative blood calcium < 2.225 mmol/L was significantly worse than that with a higher calcium level. The correspondent sensitivity was 0.812 with a specificity of 0.633.ConclusionOperative treatment for RPD achieved good results, while in some cases the functional scores remain inferior. As a serum biomarker, preoperative calcium could be prognostic for outcomes after surgical treatment for RPD.

Early Hypocalcemia after Sub-Total, Near-Total and Total Thyroidectomy: its Diagnosis and Treatment Options

Introduction: Hypocalcemia after thyroid surgery is most important and early complication1. The main aim of this study is to diagnose early hypocalcemia after thyroid surgery and its treatment options Method: 100 patients fulfilling inclusion criteria from December 2018 to February 2021 were included in this study who had undergone thyroid surgery (sub-total, near-total and total). Serum calcium less than 8.1 mg/dl, measured after 24 hours to 48 hours of surgery is taken as hypocalcemia. Following variables are assessed in this study, gender, age, pre-operative serum calcium levels and type of surgery. Hypocalcemia diagnosed by post-operative serum calcium levels, presence of numbness, Chvostek’s sign or Trousseau’s sign noted and analyzed by SPSS v20 was used for statistical analysis. p-value less than 0.05 was considered as statistically significant. Results: Early post-hypocalcemia developed in 71 (71%) patients of them 13(18%) were males and 58 (82%) were females and female gender is significantly more associated with hypocalcemia (p=0.001) Type of surgery (sub-total, near-total and total) is not related to development of early hypocalcemia (p=0.169). Patients who developed early hypocalcemia divided into two groups- A and B respectively. Group A is treated with oral calcium alone and B with oral calcium combined with Vitamin D3. The patients followed up for 6 months. The patients who treated with oral calcium and vitamin D3 combined responded well as compares with oral calcium alone (p=.001). Conclusion: This study suggests that female gender is associated with early hypocalcemia however there is no significant different type of surgery and patients who treated with oral calcium combined with vitamin D3 responded well as compared with oral calcium alone. Keywords: Early Hypocalcemia, thyroid surgery, Goiter

Is preoperative parathyroid localization necessary for tertiary hyperparathyroidism?

BackgroundThe role of preoperative parathyroid localization for tertiary hyperparathyroidism(tHPT) is unclear. We reviewed our experience regarding the feasibility of parathyroidectomy without preoperative localization. MethodsThis is a retrospective study of renal allograft recipients who underwent parathyroidectomies (2001–2019). Patients with normal preoperative serum calcium and PTH levels or previous cervical operations were excluded. Patient demographics, laboratory results, radiology reports, pathology reports, and clinical notes were reviewed. Wilcoxon signed rank test, Mann-Whitney U test, Fisher's exact and Pearson chi-square analysis were used to compare patients with and without preoperative localization. ResultsOf the 118 patients, 25 patients(21.1%) had preoperative localization. Of the 36 ectopic glands recovered, 31(86.1%) were found without preoperative localization. All 118 patients achieved normocalcemia at the time these data were collected. There were no differences in surgical cure rate, recurrence rate, temporary hoarseness, or postoperative symptomatic hypocalcemia between the two groups. ConclusionsWe observed no differences in surgical cure rate, reoperation rate, or postoperative complications without preoperative localization. Under most circumstances, it is appropriate to perform parathyroidectomy for tHPT without localization.

Lipoadenoma of the parathyroid: characteristics of a rare cause of hyperparathyroidism.

Parathyroid Lipoadenoma (PLA) contains abundant mature adipose tissue and is a rare cause of hyperparathyroidism. This study aimed to investigate the clinical features of PLA in nine patients with primary hyperparathyroidism, including two men and seven women, with ages ranging from 45-84 years (median 60 years). PLA accounted for 0.5% of all parathyroid tumors during the study period. One patient presented with anorexia due to hypercalcemia; however, the other eight patients were asymptomatic. The median preoperative serum intact-parathyroid hormone (iPTH) and calcium levels were 143 pg/mL (range, 102-378) and 10.8 mg/dL (range, 10.3-11.3), respectively. PLA was difficult to identify using ultrasonography (US) as it appears as a moderately hyperechoic nodule and is difficult to distinguish from the surrounding adipose tissues. Only 33% of the lesions (three out of nine lesions) were accurately identified. However, they could be distinctly differentiated from the surrounding tissue using computed tomography (CT). All PLAs were also detected using the sesta-methoxyisobutylisonitrile single-photon emission-computed tomography (SPECT). All the patients were treated by a single gland extirpation. The median size and weight of the PLA were 14 mm (range, 10-22) and 567 mg (range, 200-1,533), respectively. In conclusion, the clinical manifestations of PLA are similar to those of ordinal parathyroid adenomas, except for their unique US and CT images. PLA should be considered as a potential etiologic factor in cases of hyperparathyroidism when the lesions are demonstrated as hyperechoic nodules or unidentified by US but detected by CT or SPECT imaging.

Hypocalcemia in patients undergoing bilateral thyroid surgery: A clinical study

Background: Hypocalcemia after thyroid surgery is a common complication that can cause severe short- and long-term morbidity. The goal of this study was to see how often post-thyroidectomy hypocalcaemia (defined as a corrected calcium of less than 2.1 mmol/l) was and what factors could predict it in a tertiary surgical center.Aims: The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Materials and Methods: The present prospective study was conducted in department of general surgery in 40 patients who had their thyroids removed bilaterally were studied. The research was conducted from March 2017 to February 2019. Serum calcium estimation was used to determine the incidence of hypocalcemia in the immediate post-operative period, 4 hours, and 24 hours following surgery, and on the 5th post-operative day. Pre-operative and post-operative serum calcium levels, clinical manifestations, and disease type all patients were examined.Results: Mean age of the patients was 48.2±14.90 years with a range of 21-70 years. Maximum number of patients had colloid goitre on FNAC i.e., 18 (45%) followed by atypical cells s/o malignancy in 9 (22.5%) patients. In 32 (80%) patients, total thyroidectomy was performed and in 8 (20 %) patients subtotal thyroidectomy was performed. Mean serum calcium preoperatively was 9.0±0.2 and when it was compared with serum calcium level in immediate postoperative, 4 hours after surgery, 24 hours after surgery and 5 days after surgery, it showed a significant difference (p

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients.

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence.

Preoperative Low Serum Calcium Levels Predict Poor Prognosis for Patients with Esophageal Cancer.

Purpose: Hypercalcemia has been reported as a poor prognostic factor in malignant tumors. However, no report has shown the clinical impact of serum calcium levels on patients with esophageal cancer. We evaluated the prognostic impact of preoperative serum calcium levels on patients with esophageal cancer.Methods: We evaluated 240 patients (197 men, 43 women; mean age, 66 years; age range, 34–85 years) with esophageal cancer who underwent radical surgery between September 2008 and December 2017. After assigning the patients to two groups (high calcium group, 8.8 mg/dL or more and low calcium group, 8.7 mg/dL or less), we compared the groups’ overall survival and the clinicopathological features. The clinicopathological and prognostic significance of preoperative serum calcium levels were evaluated in a univariate and multivariate analysis.Results: The patients with deep tumors showed low serum calcium levels significantly more frequently (P <0.05). The low calcium group showed a significantly worse prognosis than the high calcium group (P <0.05). However, low serum calcium level was not an independent poor prognostic factor.Conclusions: Preoperative low serum calcium levels were associated with advanced tumors. Low serum calcium might be associated with esophageal cancer progression.

Study of incidence of hypocalcaemia in patients undergoing total thyroidectomy for papillary carcinoma: a retrospective study

Background: Hypocalcaemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcaemia can be predicted in patients undergoing thyroid surgery for malignancy, based on serial calcium measurement and this helps in early prediction of hypocalcaemia. The aim of the study was to assess the incidence of post thyroidectomy hypocalcaemia and methods to treat hypocalcaemia and prevention of its complication at the earliest.Methods: The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery and histopathologically diagnosis as malignant papillary thyroid carcinoma is confirmed.Results: In this study 30 patients underwent total thyroidectomy for papillary carcinoma were studied. Incidence of 22% of hypocalcemia, with transient hypocalcemia in 20% and permanent hypocalcemia in 2% of cases were noted.  Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcaemia. This complication can be prevented with meticulous peroperative dissection, prompt identification of parathyroid gland. Avoiding injury or spasm of the blood vessels supplying them and frequent postoperative monitoring of serum calcium levels. 

Hypocalcemia: A possible risk factor for anastomotic leak in digestive surgery

Anastomotic leaks (ALs) remain the most severe complication in digestive surgery, as well as the most consumptive in terms of human and financial resources. There is an abundance of international research which has focused on identifying and correcting risk factors, and on individualized surgical management as well. The most frequent risk factors are male sex, obesity, diabetes, advanced malignant disease, ASA score, perioperative blood loss or perioperative transfusion, long operation time, emergency operation and altered nutritional status. The aim of the present study was to measure the preoperative serum calcium level and to find a possible correlation between calcium levels and the risk of AL occurrence. A retrospective analysis of medical records for 122 patients who underwent surgical gut resection with anastomosis for different pathologies was carried out. Preoperative serum calcium level and the occurrence of AL was noted. The results revealed that the average value of total blood calcium was 8.78 mg/dl, without a significant difference in sex groups. Hypocalcemia was identified in 44 patients (36.1%). AL was identified in 8 patients (6.6%), with a statistically insignificant difference between male and female patients. The average value of blood calcium in the AL patient group was 8.07 mg/dl, while in patients without AL the average value was 8.83 mg/dl. Hypocalcemia, defined as a serum calcium level below 8.5 mg/dl, was observed in 7 of the 8 patients presenting with AL (87.5%) and 37 patients who did not present with AL (32.5%), a significant difference with which to consider and include hypocalcemia in the group of risk factors for AL (P=0.001). In conclusion, preoperative low serum calcium level can represent a risk factor for AL in digestive surgery.

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy.

Background Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. Objectives This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. Methods We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. Results After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. Conclusions The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.

Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy.

Background Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. Methods This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. Results The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). Conclusions Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.