MON-770 - Implementation of A Standardized Post-Operative Hypocalcemia Protocol

Introduction: Patients undergoing thyroidectomy or parathyroidectomy are at risk of developing post-operative hypocalcemia. Prevention strategies include calcium and calcitriol supplementation post-operatively, but a standardized guideline for this management does not currently exist. Different algorithms include PTH and/or calcium-driven protocols. The purpose of this quality improvement study is to evaluate post-operative complications and length of stay in patients undergoing a thyroidectomy or parathyroidectomy before and after the implementation of a standardized protocol for post-operative hypocalcemia. The protocol was developed by a multidisciplinary collaboration involving an endocrine surgeon and endocrinologists at two academic hospitals in our network. The protocol combines both PTH and calcium-driven supplementation strategies by proactively initiating calcium and calcitriol supplementation based on post-operative PTH and serum calcium levels. By initiating this protocol, we hypothesized that the incidence and severity of hypocalcemia post-operatively will be reduced because of initial and adequate supplementation. In doing so, we hoped to decrease overall hospital length of stay, 30-day readmission rates as well as the incidence of symptomatic post-operative hypocalcemia.

Methods: Patients who underwent total thyroidectomy, completion thyroidectomy, or parathyroidectomy were reviewed. A total of 238 cases were reviewed from January 1, 2022 to January 1, 2025 as a part of our retrospective cohort. Of these, 165 met our inclusion criteria. Our prospective cohort includes 59 patients so far and ran between January 1, 2025 and January 1, 2026.

Results: Of the 165 patients reviewed in the retrospective part of this study, 3 patients (1.8%) were complicated by readmission within 30 days for hypocalcemia, 11 patients (6.7%) developed post-operative hypocalcemia, and the average length of stay was 1.4 days. Of the 59 patients reviewed so far in our prospective cohort that met our inclusion criteria, 0 patients (0%) were readmitted for symptomatic hypocalcemia within 30 days. 2 patients (3.4%) developed post-operative hypocalcemia, and the average length of stay was 1.15 days.

Discussion: After implementation of our protocol, our results demonstrate a clear decrease in hospital readmission, length of stay and development of hypocalcemic symptoms in patients who are placed on our protocol after surgery. This protocol may serve as a guide for the management of these patients at other institutions.

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