TH8.4 The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism

Aims Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHPT) and is often the cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHPT, current guidance recommends a day-case rate of 90% for patients undergoing surgery for primary hyperparathyroidism. Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHPT. This protocol, developed in conjunction with the renal physicians, involves giving the patients alpha calcidol pre-operatively for 5 days, to minimise the incidence of hypocalcaemia, and close monitoring of the calcium levels post operatively, to permit safe discharge. Methods We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHPT between February 2005 and May 2021. All the patients received the alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected. Results 49 patients underwent a total parathyroidectomy during the study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. Reasons for prolonged hospital stay in the remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patients required readmission during the 30-day post-operative period. Conclusion Day-case surgery for SHPT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.