Predictive Factors for Postoperative Early Hypocalcemia in Patients Operated by a Focused Surgical Approach for Primary Hyperparathyroidism Due to Solitary Parathyroid Adenoma

There are quite a lot of studies investigating preoperative factors that might be used to predict postoperative hypocalcemia (PH) in thyroidectomized patients; however, there are less studies in parathyroidectomized patients, especially in patients who underwent single parathyroid adenoma excision by using the focused surgical approach. In this study, our aim was to determine whether any preoperative clinical, laboratory, or ultrasonographical feature anticipates PH in parathyroidectomized patients due to primary hyperparathyroidism (PHPT). All patients who operated for PHPT between 2019 and 2021 were retrospectively evaluated. Patients undergoing single parathyroidectomy by using the focused surgical approach were included in the study. Demographic, clinical, ultrasonography, and histopathology results were noted and compared in patients with and without early PH within 4 days after surgery. Of 181 parathyroidectomized patients, 98 underwent focused parathyroidectomy for single parathyroid adenoma. PH was observed in 36 (36.7%) patients. Patients with PH were younger compared to without PH (p = 0.018). Gender distribution and the presence of osteoporosis were comparable. Nephrolithiasis was less prevalent in the hypocalcemia group (p = 0.034). Preoperative levels of calcium, phosphorus, magnesium, parathyroid hormone, alkaline phosphatase, and 25 OH vitamin D were similar in the two groups. Fractional excretion of calcium (FECa) was lower in the PH group (p = 0.045, p = 0.001). Ultrasonographic and histopathologic diameters and volumes of parathyroid lesions were not different in both groups (p > 0.05 for all). In the multivariate analysis, only being 50.5 years old or younger and without nephrolithiasis were found to be associated with PH (p = 0.016, p = 0.026). Patients younger than 50.5 age and without nephrolithiasis might require closer follow-up for the development of early PH.