Assessment of Inter-Institutional Post-Operative Hypoparathyroidism Status Using a Common Data Model

Post-thyroidectomy hypoparathyroidism may result in various transient or permanent symptoms, ranging from tingling sensation to severe breathing difficulties. Its incidence varies among surgeons and institutions, making it difficult to determine its actual incidence and associated factors. This study attempted to estimate the incidence of post-operative hypoparathyroidism in patients at two tertiary institutions that share a common data model, the Observational Health Data Sciences and Informatics. This study used the Common Data Model to extract explicitly specified encoding and relationships among concepts using standardized vocabularies. The EDI-codes of various thyroid disorders and thyroid operations were extracted from two separate tertiary hospitals between January 2013 and December 2018. Patients were grouped into no evidence of/transient/permanent hypoparathyroidism groups to analyze the likelihood of hypoparathyroidism occurrence related to operation types and diagnosis. Of the 4848 eligible patients at the two institutions who underwent thyroidectomy, 1370 (28.26%) experienced transient hypoparathyroidism and 251 (5.18%) experienced persistent hypoparathyroidism. Univariate logistic regression analysis predicted that, relative to total bilateral thyroidectomy, radical tumor resection was associated with a 48% greater likelihood of transient hypoparathyroidism and a 102% greater likelihood of persistent hypoparathyroidism. Moreover, multivariate logistic analysis found that radical tumor resection was associated with a 50% greater likelihood of transient hypoparathyroidism and a 97% greater likelihood of persistent hypoparathyroidism than total bilateral thyroidectomy. These findings, by integrating and analyzing two databases, suggest that this analysis could be expanded to include other large databases that share the same Observational Health Data Sciences and Informatics protocol.

Assessment of inter-institutional post-operative hypoparathyroidism status using a common data model (Preprint)

BACKGROUND Post-thyroidectomy hypoparathyroidism may result in various transient or permanent symptoms, ranging from tingling sensation to severe breathing difficulties. Its incidence varies among surgeons and institutions, making it difficult to determine its actual incidence and associated factors. OBJECTIVE This study attempted to estimate the incidence of post-operative hypoparathyroidism in patients at two tertiary institutions that share a common data model, the Observational Health Data Sciences and Informatics. METHODS This study used the Common Data Model to extract explicitly specified encoding and relationships among concepts using standardized vocabularies. The EDI-codes of various thyroid disorders and thyroid operations were extracted from two separate tertiary hospitals between January 2013 and December 2018. Patients were grouped into no evidence of/transient/permanent hypoparathyroidism groups to analyze the likelihood of hypoparathyroidism occurrence related to operation types and diagnosis RESULTS Of the 4848 eligible patients at the two institutions who underwent thyroidectomy, 1370 (28.26%) experienced transient hypoparathyroidism and 251 (5.18%) experienced persistent hypoparathyroidism. Univariate logistic regression analysis predicted that, relative to total bilateral thyroidectomy, radical tumor resection was associated with a 48% greater likelihood of transient hypoparathyroidism and a 102% greater likelihood of persistent hypoparathyroidism. Moreover, multivariate logistic analysis found that radical tumor resection was associated with a 50% greater likelihood of transient hypoparathyroidism and a 97% greater likelihood of persistent hypoparathyroidism than total bilateral thyroidectomy. CONCLUSIONS These findings, by integrating and analyzing two databases, suggest that this analysis could be expanded to include other large databases that share the same Observational Health Data Sciences and Informatics protocol.

Analysis of Risk Factors for Hypoparathyroidism After Total Thyroidectomy

Objective: To analyze the risk factors of hypoparathyroidism after total thyroidectomy.Methods: Clinical data of patients who undergo total thyroidectomy in the Luwan Branch of Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University was collected from January 2015 to December 2018, retrospectively. Logistic regression was used to analyze the risk factors associated with transient and long-term hypoparathyroidism.Results: A total of 537 patients were collected. The patients' average age included in the study was 47.3 ± 12.7 years old, including 135 males (25.1%) and 702 females (74.9%). There were 194 patients (36.1%) with transient postoperative hypoparathyroidism, and 21 patients (3.9%) had long-term postoperative hypoparathyroidism. After multivariate analysis, the main risk factors related to postoperative transient hypoparathyroidism were gender (P = 0.038, OR 0.686), combined lymph node dissection (P = 0.008, OR 1.569), and the maximum diameter of the thyroid (P = 0.011, OR 1.192), second operation (P = 0.001, OR 1.974), preoperative blood calcium (P < 0.001, OR 0.028). The main risk factors associated with long-term postoperative hypoparathyroidism are combined with lymph node dissection (P = 0.011, OR 1.594), maximum thyroid diameter (P = 0.032, OR 1.254), and PTH on the first day after surgery (P < 0.001, OR 1.199).Conclusions: Gender, combined lymph node dissection, maximum thyroid diameter, a second surgery, and preoperative blood calcium are risk factors for transient hypoparathyroidism after thyroid surgery. The combined lymphatic dissection and the thyroid gland's maximum diameter are risk factors for long-term hypoparathyroidism after thyroid surgery. PTH on the first day after surgery has a predictive effect on patients with long-term hypoparathyroidism.

The role of carbon nanoparticle in lymph node detection and parathyroid gland protection during thyroidectomy for non-anaplastic thyroid carcinoma- a meta-analysis

Objective To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). Methods A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). Results 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). Conclusions The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.

Severe Hypocalcemia and Transient Hypoparathyroidism After Hyperthermic Intraperitoneal Chemotherapy

Dear Editors,Hypocalcemia is not unusual in patients hospitalized for critical illness and has also been described after general surgery in addition to head and neck surgical procedures 1 2 3. Hypocalcemic events commonly occur in the setting of massive blood transfusion, albumin deficiency, vitamin D deficiency, and/or hypomagnesemia. In the absence of these factors, only slight decreases in calcium levels within the normal range have been reported during surgical procedures 1. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) causing asymptomatic hypocalcemia has only been reported in two previous studies 4 5. The etiology is unclear. We here report a patient who developed severe symptomatic hypocalcemia likely as a result of a profound inflammatory reaction with transient hypoparathyroidism after HIPEC.

Calcinosis cutis in a neonate with transient hypoparathyroidism

Calcinosis cutis is a condition, where there is deposition of calcium salts in skin and subcutaneous tissue, seen often in the middle to elderly aged population and is rare in neonates and infants. There are many aetiological factors, but in neonates and infants it is mostly seen as complication of extravasation of intravenous calcium infusion or trauma. For uncomplicated cases supportive treatment has been advocated. Authors describe a case presented with calcinosis cutis, who was treated for transient hypoparathyroidism in neonatal period.

Assessment between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy: a record based study

Background: Hypoparathyroidism is a major complication of thyroidectomy. The association between the number of parathyroid glands preserved and hypoparathyroidism is not well understood. The objectives of the study were to evaluate the clinical characteristics and the frequency of hypoparathyroidism during thyroidectomy, and to determine the minimum number of parathyroid glands that need to be preserved to prevent hypoparathyroidism.Methods: A retrospective study was conducted in Department of Surgery in Tertiary care hospital from January 2016 to December 2017. Around 250 patients who underwent total thyroidectomy for papillary thyroid carcinoma were analysed. We evaluated the frequency of hypoparathyroidism according to the number of parathyroid glands preserved.Results: Incidental parathyroidectomy occurred in 20% of the patients; one parathyroid gland in 16%, two in 1.5%, and three in 0.9%. Transient hypoparathyroidism was increased when incidental parathyroidectomy occurred (odds ratio 1.63, 95% confidence interval 1.07 to 3.13, p=0.03). There was no significant relationship between the number of parathyroid glands preserved and permanent hypoparathyroidism (p=0.16).Conclusions: Conservation of all parathyroid glands decreases transient hypoparathyroidism equated with when three or fewer glands are preserved but does not affect permanent hypoparathyroidism.

The Role of Carbon Nanoparticle in Lymph Node Detection and Parathyroid Gland Protection during Thyroidectomy- a Meta Analysis

ObjectiveTo assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland protection during thyroidectomy.MethodsA systematic literature search for relevant literatures published up to December 2018 in PubMed, Embase, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials on the use of CNs during thyroidectomy were enrolled in this study. The primary outcomes included the number of lymph nodes harvesed, rate of lymph nodes involvement, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between-study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5).Results25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the groups of carbon nanoparticles was significant higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating carbon nanoparticles was associated with a lower incidence of accidental parathyroid gland removal (OR = 0.30, 95% CI = 0.23 to 0.40, P <0.01) and lower rates of both postoperative transient hypoparathyroidism (OR =0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR =0.55, 95% CI = 0.09 to 3.43, P =0.52). There was no significant difference of identified lymph node metastatic rates between the patients with and without use of carbon nanoparticles. Subgroup analyses indicated that the application of CNs in thyroid cancer reoperation also decreased the rate of transient hypoparathyroidism (OR =0.20, 95% CI = 0.36 to 0.04, P =0.01) and the possibility of accidental parathyroid glands removal (OR = 0.19, 95% CI = 0.05 to 0.73, P<0.05).ConclusionsThe application of CNs for thyroidectomy results in higher number of lymph node harvested and better parathyroid gland protection during initial surgery and reoperation for thyroid cancer.

Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.