Abstract
Background: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. Methods: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were “preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL). Results: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. Conclusions: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The “preventive” strategy was the most cost-effective, despite overtreatment.
| Original language | English |
|---|---|
| Journal | Head and Neck |
| DOIs | |
| Publication status | Accepted/In press - Jan 1 2019 |
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Keywords
- cost
- effectiveness
- hypocalcemia
- thyroidectomy
- transient
ASJC Scopus subject areas
- Otorhinolaryngology
Cite this
Cost-effectiveness in transient hypocalcemia post-thyroidectomy. / Mercante, Giuseppe; Anelli, Andrea; Giannarelli, Diana; Giordano, Davide; Sinopoli, Ilenia; Ferreli, Fabio; Digiesi, Giovanna; Appetecchia, Maria L.; Barnabei, Agnese; Cristalli, Giovanni; Conti, Laura; Pellini, Raul; Fabio, Piazza; Lombardi, Davide; De Virgilio, Armando; Spriano, Giuseppe.
In: Head and Neck, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cost-effectiveness in transient hypocalcemia post-thyroidectomy
AU - Mercante, Giuseppe
AU - Anelli, Andrea
AU - Giannarelli, Diana
AU - Giordano, Davide
AU - Sinopoli, Ilenia
AU - Ferreli, Fabio
AU - Digiesi, Giovanna
AU - Appetecchia, Maria L.
AU - Barnabei, Agnese
AU - Cristalli, Giovanni
AU - Conti, Laura
AU - Pellini, Raul
AU - Fabio, Piazza
AU - Lombardi, Davide
AU - De Virgilio, Armando
AU - Spriano, Giuseppe
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. Methods: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were “preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL). Results: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. Conclusions: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The “preventive” strategy was the most cost-effective, despite overtreatment.
AB - Background: Three different strategies to manage transient hypocalcemia after total thyroidectomy were compared to evaluate cost-effectiveness. The reliability of total serum calcium (TSCa), ionized calcium (ICa), and intact parathyroid hormone (iPTH) were investigated to achieve this goal. Methods: A multicenter, prospective randomized study was carried out with 169 patients. The strategies were “preventive” (oral calcium + vitamin D supplementation), “reactive” (therapy in hypocalcemia), and “predictive” (therapy if iPTH <10 pg/mL). Results: TSCa had higher accuracy in identifying patients who developed hypocalcemia-related symptoms than ICa (84.6% vs 50.0%). TSCa 24 h after surgery showed 24.8% of patients with hypocalcemia, whereas TSCa 48 h after surgery identified a further 10.6% with hypocalcemia (only in the “reactive” and “predictive” groups). iPTH showed low sensitivity as a predictor of hypocalcemia. Between the 3 groups, there was no significant difference in hospitalization time or number of symptomatic hypocalcemic patients. Interestingly, the cost-per-patient was significantly different among the groups. Conclusions: None of the discussed strategies allowed for early discharge of patients without any risk of transient hypocalcemia. The “preventive” strategy was the most cost-effective, despite overtreatment.
KW - cost
KW - effectiveness
KW - hypocalcemia
KW - thyroidectomy
KW - transient
UR - http://www.scopus.com/inward/record.url?scp=85071501510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071501510&partnerID=8YFLogxK
U2 - 10.1002/hed.25934
DO - 10.1002/hed.25934
M3 - Article
AN - SCOPUS:85071501510
JO - Head and Neck Surgery
JF - Head and Neck Surgery
SN - 1043-3074
ER -