Perioperative Management Practices in Thyroid Surgery- Heterogeneity in postoperative hypoparathyroidism management in The Netherlands

Author(s): Max H.M.C. Scheepers, Zaid J.J. Al-Difaie, Bjorn Winkens, Bas Havekes, Sanne Engelen, Tessa van Ginhoven, Els Nieveen van Dijkum, Schelto Kruijff, Nicole D. Bouvy.

Background: One of the most feared complications following thyroid surgery is postoperative hypoparathyroidism, which frequently results in hypocalcemia. In this study, perioperative management practices for thyroid surgery across the Netherlands were evaluated, with focus on differences among healthcare professionals in academic and general hospitals.

Methods: We conducted a 27-question online survey developed in collaboration with the Dutch Thyroid Cancer Group (DTCG). The survey was open from October 31 to December 19, 2023, collected responses from physicians in 24 hospitals, achieving a response rate of 77.0% at the hospital level. Differences in responses were assessed between physician types and between academic and general hospitals using Fisher’s exact test.

Results: The survey revealed a significant variation in the definitions of transient and permanent postoperative hypoparathyroidism, preoperative testing for vitamin D levels, and the use of intraoperative techniques to identify parathyroid glands. The definitions provided by surgeons and endocrinologists differed significantly for transient and permanent hypoparathyroidism (p=0.021 and 0.028). There was a significant difference in how hospitals prescribed calcium and/or vitamin D supplements after surgery (p=0.026).

Conclusion: Our findings highlight inconsistencies in defining postoperative hypoparathyroidism and differences in managing postsurgical hypocalcemia in the Netherlands. The varying definitions of postoperative hypoparathyroidism highlight the need for uniform definitions to harmonize clinical and research practices. Consistent perioperative practices are needed to reduce the number of postoperative complications. Future research should focus on optimising preoperative risk factors for postoperative hypocalcaemia, ensuring accurate identification of parathyroid glands during surgery, and investigating the benefits of prophylactic postoperative calcium supplementation.