A safe protocol for same day discharge following total parathyroidectomy for secondary hyperparathyroidism: a retrospective cohort study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Introduction:
Total parathyroidectomy on patients with secondary hyperparathyroidism traditionally
requires an inpatient hospital stay to monitor them for postoperative hypocalcaemia.
Our centre developed a protocol in 2015 with the aim of carrying out total
parathyroidectomies as a day case procedure. This protocol involves giving the patient
oral alfacalcidol preoperatively for 5 days and close monitoring of the calcium levels
postoperatively to permit safe same-day discharge.
Methods:
A single centre retrospective cohort study was undertaken on all patients who
underwent a total parathyroidectomy for secondary hyperparathyroidism between 2005
and 2022. A comparison study was done before and after the protocol was introduced
in 2015. Data was collected to look into the patient comorbidities, calcium, potassium,
and parathyroid hormone levels, length of hospital stay, readmission, and 30-day
morbidity between the two groups.
Results:
57 patients underwent total parathyroidectomy (22 pre-protocol, 35 post-protocol). The
incidence of postoperative hypocalcaemia was lower in the post-protocol group. On
multivariable logistic regression analysis, the protocol was associated with reduced
odds of hypocalcaemia (OR 0.31, 95% CI 0.05–2.12, p=0.234). 40.0% of patients in
the post-protocol group were discharged on the same day compared with 4.54% in the
pre-protocol group. Median length of stay decreased from 2 to 1 day (p<0.001). No
patients required readmission within 30 days.
Conclusion:
Same-day discharge following total parathyroidectomy can be performed in carefully
selected patients using a preoperative regimen of alfacalcidol and close postoperative
calcium monitoring, thereby emulating a virtual ward model.
Total parathyroidectomy on patients with secondary hyperparathyroidism traditionally
requires an inpatient hospital stay to monitor them for postoperative hypocalcaemia.
Our centre developed a protocol in 2015 with the aim of carrying out total
parathyroidectomies as a day case procedure. This protocol involves giving the patient
oral alfacalcidol preoperatively for 5 days and close monitoring of the calcium levels
postoperatively to permit safe same-day discharge.
Methods:
A single centre retrospective cohort study was undertaken on all patients who
underwent a total parathyroidectomy for secondary hyperparathyroidism between 2005
and 2022. A comparison study was done before and after the protocol was introduced
in 2015. Data was collected to look into the patient comorbidities, calcium, potassium,
and parathyroid hormone levels, length of hospital stay, readmission, and 30-day
morbidity between the two groups.
Results:
57 patients underwent total parathyroidectomy (22 pre-protocol, 35 post-protocol). The
incidence of postoperative hypocalcaemia was lower in the post-protocol group. On
multivariable logistic regression analysis, the protocol was associated with reduced
odds of hypocalcaemia (OR 0.31, 95% CI 0.05–2.12, p=0.234). 40.0% of patients in
the post-protocol group were discharged on the same day compared with 4.54% in the
pre-protocol group. Median length of stay decreased from 2 to 1 day (p<0.001). No
patients required readmission within 30 days.
Conclusion:
Same-day discharge following total parathyroidectomy can be performed in carefully
selected patients using a preoperative regimen of alfacalcidol and close postoperative
calcium monitoring, thereby emulating a virtual ward model.
Date Acceptance
2026-08-14
Citation
Annals of Medicine and Surgery
ISSN
2049-0801
Publisher
Elsevier
Journal / Book Title
Annals of Medicine and Surgery
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
Identifier
https://symplectic.imperial.ac.uk/userprofile.html?uid=183392
Subjects
Endocrine Surgical Procedures
Hyperparathyroidism, Secondary
Hypocalcemia
Parathyroid Diseases
Publication Status
Accepted
Coverage Spatial
United Kingdom