Cheng Shih-Ping, Liu Chien-Liang, Chen Han-Hsiang, Lee Jie-Jen, Liu Tsang-Pai, Yang Tsen-Long
Department of Surgery, Mackay Memorial Hospital, 92, Sec 2, and Department and Institute of Pharmacology, National Yang-Ming University, Chung-Shan North Road, Taipei, 10449, Taiwan.
World J Surg. 2009 Jan;33(1):72-9. doi: 10.1007/s00268-008-9787-2.
Protracted hypocalcemia is the most common complication after parathyroidectomy for secondary hyperparathyroidism. Several parameters have been identified to predict the degree of postoperative hypocalcemia. The purpose of this study was to determine whether there were any factors associated with prolonged hospitalization in these patients.
A total of 81 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between January 2004 and December 2006 were studied. The postoperative calcium infusion protocol and discharge criteria were standardized. Clinical variables were compared between patients with a shorter or longer postoperative stay.
The mean postoperative hospital stay was 5.6 days. Preoperative alkaline phosphatase levels were significantly higher in patients with a longer stay (p=0.035). In a linear regression model, the postoperative length of stay was moderately but significantly correlated with preoperative alkaline phosphatase levels (R2=0.254; p<0.001). Receiver operating characteristic analysis showed a significant area under the curve (0.678; 95% confidence interval 0.550-0.805; p=0.014). With a cutoff of preoperative alkaline phosphatase levels at 200 IU/L, the sensitivity was 0.57 and the specificity was 0.59 for predicting a prolonged stay.
A high preoperative alkaline phosphatase level is significantly associated with prolonged hospital stay in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
持续性低钙血症是甲状旁腺切除术后治疗继发性甲状旁腺功能亢进最常见的并发症。已确定了几个参数来预测术后低钙血症的程度。本研究的目的是确定这些患者中是否存在与住院时间延长相关的因素。
对2004年1月至2006年12月期间连续接受甲状旁腺切除术的81例终末期肾病和晚期继发性甲状旁腺功能亢进患者进行了研究。术后钙输注方案和出院标准进行了标准化。比较了术后住院时间较短或较长的患者之间的临床变量。
术后平均住院时间为5.6天。住院时间较长的患者术前碱性磷酸酶水平显著更高（p=0.035）。在线性回归模型中，术后住院时间与术前碱性磷酸酶水平呈中度但显著的相关性（R2=0.254；p<0.001）。受试者工作特征分析显示曲线下面积显著（0.678；95%置信区间0.550-0.805；p=0.014）。以术前碱性磷酸酶水平200 IU/L为临界值，预测住院时间延长的敏感性为0.57，特异性为0.59。
术前碱性磷酸酶水平高与接受甲状旁腺切除术治疗继发性甲状旁腺功能亢进的患者住院时间延长显著相关。
