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The impact of operative duration and intraoperative fluid dynamics on postoperative hypocalcemia after total thyroidectomy: a prospective non-randomized study

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Abstract

Background

Postoperative hypocalcemia after total thyroidectomy (TT) still remains common. This prospective observation study examined the role of intraoperative time period (IOP) and intravenous fluids (IVF) in transient and permanent (> 6 months) hypocalcemia post-TT.

Subjects and method

Consecutive patients (n = 328; age = median (IQR); 34 (15) years; M:F = 65:263) with benign or malignant thyroid disease undergoing TT were evaluated for IOP, intraoperative IVF, serum corrected calcium, intact parathormone (iPTH), and 25-hydroxyvitamin D (25OHD) levels at baseline, 48 h, and 6 months post-TT.

Results

The incidence of symptomatic transient and permanent hypocalcemia post-TT was 33.5% and 7.9% respectively. In multivariate logistic regression analysis, the independent risk factors for transient hypocalcemia were IOP (odds ratio: 11.6), 48-h iPTH (4.8), IVF (2.9), hyperthyroidism (2.8), and percent calcium decline (1.07), while 25OHD deficiency increased the risk by 10.5 odds in subset with preoperative hypocalcemia. In receiver operating characteristic analysis, IOP, and IVF strongly predicted transient hypocalcemia with a threshold of 123 min and 1085 mL. Area under the curve, sensitivity, and specificity were 0.883 (95% CI: 0.838–0.928), 88.1%, and 74.4% and 0.883 (0.840–0.926; each P = 0.001), 84.4%, and 74.4% respectively. Serum 48-h calcium < 7.8 mg/dL was the only reliable predictor of permanent hypocalcemia.

Conclusion

Operative duration > 123 min and IVF > 1085 mL increased the risk of transient hypocalcemia post-TT manyfold but not permanent hypocalcemia. Routine intraoperative identification, preservation of viable in situ parathyroid glands, and laryngeal nerves increased IOP and rates of transient hypocalcemia but improved long-term outcome.

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Data availability

Dataset for the current study will be made available from the corresponding author on reasonable request.

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Acknowledgments

We thank Prof. Dr. K. Ramadevi MD, PhD., Professor, and Director, Institute of Biochemistry, Madras Medical College, Chennai, for her help in the analysis of biochemical parameters and interpretation of results.

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Authors and Affiliations

  1. The Tamilnadu Dr MGR Medical University, Chennai, 600032, India

    Poongkodi Karunakaran

  2. Endocrine Surgery Unit, Government Mohan Kumaramangalam Medical College, Salem, 636030, India

    Poongkodi Karunakaran

  3. Department of Endocrine Surgery, Madras Medical College, Chennai, Tamilnadu, 600003, India

    Poongkodi Karunakaran & Zahir Hussain

  4. Department of Endocrine Surgery, Christian Medical College, Vellore, 632004, India

    Deepak Thomas Abraham

  5. Institute of Pathology, Madras Medical College, Chennai, 600003, India

    Geetha Devadas

  6. ICMR-National Institute for Research in Tuberculosis, Chetpet, Chennai, 600031, India

    Srinivasan Ramalingam

  7. Department of Biochemistry, Government Stanley Medical College and Hospital, Chennai, 600001, India

    Sudhapresanna Balu

Authors
  1. Poongkodi Karunakaran
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  2. Deepak Thomas Abraham
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  4. Srinivasan Ramalingam
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  5. Sudhapresanna Balu
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  6. Zahir Hussain
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Dr. K. Poongkodi. Acquisition of data and interpretation of results were done by Dr. Sudhapressana Balu. Dr. Srinivasan Ramalingam performed the statistical analysis. The first draft of the manuscript was written by Dr. K Poongkodi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Poongkodi Karunakaran.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval (No. 18092012) was granted by Institutional Ethics Committee, Madras Medical College, Chennai, 600003. All procedures performed in this study were in accordance with the ethical standards of Institutional Ethics Committee and 1964 Helsinki declaration and its later amendments.

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Informed written consent was obtained from all the individual participants included in the study.

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Informed written consent was obtained from all the patients included in the study regarding participation in this research, publication of their data, and photographs.

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Karunakaran, P., Abraham, D.T., Devadas, G. et al. The impact of operative duration and intraoperative fluid dynamics on postoperative hypocalcemia after total thyroidectomy: a prospective non-randomized study. Langenbecks Arch Surg 406, 1211–1221 (2021). https://doi.org/10.1007/s00423-020-02013-8

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  • DOI: https://doi.org/10.1007/s00423-020-02013-8

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