From the Guidelines
Post-operative care for parathyroidectomy involves close monitoring of calcium levels and supplementation as needed.
Key Components of Post-Operative Care
- Monitoring of ionized calcium levels: Every 4 to 6 hours for the first 48 to 72 hours after surgery, and then twice daily until stable 1.
- Calcium supplementation: If ionized calcium levels fall below normal (<0.9 mmol/L or <3.6 mg/dL), a calcium gluconate infusion should be initiated at a rate of 1 to 2 mg elemental calcium per kilogram body weight per hour and adjusted to maintain normal ionized calcium levels 1.
- Oral calcium and vitamin D supplementation: Once oral intake is possible, patients should receive calcium carbonate 1 to 2 g 3 times a day, as well as calcitriol of up to 2g/day, with adjustments as necessary to maintain normal ionized calcium levels 1.
- Phosphate management: Patients who were receiving phosphate binders prior to surgery may need to discontinue or reduce this therapy, and some may require phosphate supplements, depending on serum phosphorus levels 1.
Management of Hypocalcemia
- Calcium gluconate infusion: Should be gradually reduced when ionized calcium levels return to normal and remain stable 1.
- Oral supplementation: Should be adjusted as necessary to maintain normal ionized calcium levels 1.
From the Research
Post-Operative Care Plan for Parathyroidectomy
The post-operative care plan for a patient after parathyroidectomy involves several key components to ensure a smooth and safe recovery.
- Monitoring for Hypocalcemia: Patients should be observed postoperatively for hypocalcemia and symptoms of hypocalcemia, as it is a common complication after parathyroidectomy 2.
- Calcium Supplementation: Calcium supplementation may be indicated postoperatively to prevent hypocalcemia, especially in patients with end-stage renal disease 3, 4.
- Vitamin D Supplementation: Vitamin D supplementation, particularly with active vitamin D metabolites like calcitriol, can be valuable in preventing and treating post-parathyroidectomy hypocalcemia 4.
- Follow-up Care: Daily follow-up of both serum calcium and phosphorus levels is mandatory to prevent post-operative complications, such as hypocalcemia 4.
- Hospital Stay and Readmission: Patients undergoing parathyroidectomy may have a reduced hospital length of stay and lower hospital costs when enrolled in enhanced recovery after surgery (ERAS) protocols 5. However, reoperative parathyroidectomy is associated with a higher risk of readmission within 30 days 6.
- Wound Care and Complications: Patients should be monitored for hematoma and other postoperative complications, such as wound infection or seroma 2.
- Long-term Follow-up: Patients should be followed up to assess for cure, defined as eucalcemia at more than 6 months after surgery 2.
Special Considerations
Certain patient populations, such as those with end-stage renal disease, may require special consideration and management to prevent post-operative complications, such as hypocalcemia 3, 4. Additionally, patients undergoing reoperative parathyroidectomy may be at higher risk for complications and readmission 6.