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A reappraisal of risk factors for early hypocalcemia after parathyroidectomy in dialysis patients

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Abstract

We aimed to identify risk factors for early hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism. We retrospectively enrolled 106 of 120 consecutive patients with secondary hyperparathyroidism who underwent parathyroidectomy between January 2019 and July 2021. Perioperative laboratory parameters, preoperative computerized tomography (CT) images, and postoperative histology were evaluated. Parathyroid calcification was defined as hyperdense regions with a density of > 130 Hounsfield Units on CT images of the parathyroid. Subtotal parathyroidectomy, total parathyroidectomy without auto-transplantation, or total parathyroidectomy with auto-transplantation were performed in the present study. Postoperative hypocalcemia was defined as a serum calcium concentration < 2.1 mmol/L within 4 days of surgery. The participants were categorized according to the presence (n = 33) or absence (n = 73) of postoperative hypocalcemia. The demographics, comorbidities, and surgical details were similar in the two groups. Multivariate analysis showed that the preoperative alkaline phosphatase activity, serum intact parathyroid hormone and calcium concentrations, and parathyroid calcification were independent risk factors for postoperative hypocalcemia (all P < 0.05). Receiver operating characteristic analysis generated areas under the curves for preoperative alkaline phosphatase, intact parathyroid hormone, and parathyroid calcification of 0.82, 0.80, and 0.70, respectively (all P < 0.05). Cut-off values for preoperative alkaline phosphatase (> 242.9 IU/L) and intact parathyroid hormone (> 2,104 pg/mL) were found to be predictive of postoperative hypocalcemia. High preoperative alkaline phosphatase activity and serum intact parathyroid hormone concentration and low serum calcium are associated with higher risks of postoperative hypocalcemia. Calcification of the parathyroid may represent a novel radiologic means of predicting postoperative hypocalcemia.

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Acknowledgements

We thank Mark Cleasby, PhD from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the language of a draft of this manuscript.

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  1. Long Cao and Xinzeng Sun contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, The 983th Hospital of Joint Logistic Support Force of PLA, 60 Huang Wei Road, Tianjin, 100042, People’s Republic of China

    Long Cao, Xinzeng Sun, Ting Zhang, Yue Niu, Haijin Suo, Ziwen Zhao, Chen Wang & Jianping Bai

  2. Center of Thyroid Treatment, The 983th Hospital of Joint Logistic Support Force of PLA, Tianjin, China

    Long Cao, Xinzeng Sun & Jianping Bai

Authors
  1. Long Cao
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  2. Xinzeng Sun
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  7. Chen Wang
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  8. Jianping Bai
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Contributions

Study conception and design: LC, XS and JB; acquisition of data: TZ, YN and HS; analysis and interpretation of data ZZ and CW; drafting of manuscript LC and XS; critical revision of manuscript JB.

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Correspondence to Jianping Bai.

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This study was approved by the local ethics committee. Written informed consent was obtained from all the participants.

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Cao, L., Sun, X., Zhang, T. et al. A reappraisal of risk factors for early hypocalcemia after parathyroidectomy in dialysis patients. Updates Surg 74, 1961–1970 (2022). https://doi.org/10.1007/s13304-022-01395-2

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  • DOI: https://doi.org/10.1007/s13304-022-01395-2

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