Operative treatment of primary hyperparathyroidism in daycare surgery

Objective: The standard of care for primary hyperparathyroidism is surgical removal of hyperfunctional parathyroid tissue. Here, we describe 20 patients with primary hyperparathyroidism who were treated surgically in the setting of daycare surgery. Design: Prospective observational study. Methods: A total of 20 patients with primary hyperparathyroidism were operated between March 2005 and May 2010. The follow-up period had a median of 41 weeks (5–245 weeks). Results are presented as mean (± standard deviation) or median (minimum–maximum). Results: A total of 20 patients (15 women, mean age 54 ± 14 years) were included. Nine patients were provided with post-operative calcium supplementation. One of the patients visited the emergency department the next day with paresthesia and normocalcemia; this patient was sent home. Four patients, without prophylaxis, also reported themselves to the emergency department. Only one had mild hypocalcemia (2.09 mmol/L) and was supplemented. Comparing the emergency department group (n = 5) with the others, we found that pre-operative calcium levels were similar (p = 0.40); however, the emergency department group had significantly lower post-operative calcium levels (2.27 ± 0.14 vs 2.55 ± 0.25, p = 0.008) and the decrease-percentage was significantly higher (17.5% ± 5.4% vs 10.5% ± 6.4%, p = 0.21). Conclusion: Parathyroidectomy in the daycare setting is feasible and safe. However, many patients return to the emergency department. This could be related to the strict information that is provided or due to a large decrease in their calcium levels, albeit normocalcemia. Calcium supplementation is cheap and safe, so we will provide all future patients with calcium supplementation and herewith aim to reduce the amount of emergency department visits.

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