Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4033
Peer-review started: March 31, 2021
First decision: October 16, 2021
Revised: October 28, 2021
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 6, 2022
Total parathyroidectomy (TPTX) without auto-transplantation is an effective therapeutic option for treating secondary hyperparathyroidism. However, postoperative hypocalcemia limits its clinical application.
Identify risk factors for severe hypocalcemia (SH) after TPTX, and find efficient tools for reducing or preventing SH.
To identify risk factors for SH after TPTX and compare conventional and preventive calcium supplementation (CS) regimens for their effects on SH occurrence after TPTX.
From January 2015 to May 2016, conventional CS was performed in patients who underwent TPTX, with calcium amounts adjusted according to postoperative serum calcium levels. From October 2016 to May 2018, preventive CS was performed according to preoperative alkaline phosphatase (ALP) levels. Continuous data are presented as mean ± SD and analyzed by the Student’s t-test. Categorical data are presented as numbers and percentages and analyzed using the chi-square test. Factors with P < 0.10 in univariable analysis were included in multivariable logistic regression analysis to determine the risk factors for SH.
A total of 271 patients were included. Compared with conventional CS, preventive CS led to lower occurrence rates of hypocalcemia within 48 h (46.0% vs 74.5%, P < 0.001) and SH (31.7% vs 64.1%, P < 0.001). Multivariable analysis showed that preoperative iPTH levels [odds ratio (OR) = 1.001, 95% confidence interval (CI): 1.000-1.001, P = 0.009), preoperative ALP amounts (OR = 1.002, 95%CI: 1.001-1.003, P = 0.002), preoperative serum phosphorus levels (OR = 8.729, 95%CI: 1.518-50.216, P = 0.015) and preventive CS (OR = 0.132, 95%CI: 0.067-0.261, P < 0.001) were independently associated with SH. In patients with preoperative ALP ≥ 500 U/L, only preventive CS (OR = 0.147, 95%CI: 0.038-0.562 P = 0.005) was independently associated with SH.
Preventive CS is an efficient tool for reducing the occurrence of SH after TPTX.
Preventive CS could reduce the occurrence of SH after TPTX, which might contribute to the clinical application of TPTX.