Background: Postoperative hypocalcemia is common after extensive thyroid surgery and parathyroid surgery. There are various risk factors, although there is lot of variability.
Methods and results: The aim of this project was to examine and improve postoperative monitoring and management of serum calcium at a district general hospital. Process was mapped using a flow chart and was discussed in MDT to identify areas for improvement. Data was then collected to determine whether calcium was checked on day 1 post op, 2 weeks post-op, and 8 weeks postoperatively. Discharge letters were analyzed to determine whether patients were prescribed calcium and vitamin D as per protocol and whether patients were appropriately followed up. This was followed by interventions including making a protocol for monitoring, standardizing texts and electronic prescriptions for patients undergoing surgery, leading to improvement in management facilitating early discharge, reduction in risk of hypocalcemia, readmission and treatment related hypercalcemia. Normalization of calcium levels in majority of patients was observed at one week follow up, however, no significant predictor of early normalization or hypocalcemia post-surgery was found. The findings have been used to develop an agreed local post-operative hypocalcaemia management algorithm.
Conclusion: There is no single predictor of postoperative normalization of calcium levels or development of hypocalcemia and it should be checked at various intervals at locally agreed timeline.