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Background <p>Hypocalcemia is common after cervical procedures. Patients who have undergone Roux-en-Y gastric bypass (RYGB) experience increased risk for post-thyroidectomy hypocalcemia. This association has not been elucidated for nonbariatric operations that bypass the duodenum.</p> Methods <p>A multi-institutional retrospective cohort study included patients who underwent parathyroidectomy and/or thyroidectomy with prior sleeve gastrectomy (SG), bariatric RYGB, or nonbariatric gastrojejunostomy (GJ). The primary outcomes were early (≤6 months) and late (&gt;6 months) postoperative hypocalcemia. The secondary outcomes were prolonged length of stay (&gt;24 hours) and 30-day readmission.</p> Results <p>A total of 241 patients had prior SG (39%), RYGB (44%), or GJ (17%). Early (54%) and late (41%) hypocalcemia were common. Patients with prior GJ compared with SG had significantly higher rates of early hypocalcemia (64% vs. 44% <i>p</i> = 0.04). The rate of late hypocalcemia was higher in those with prior GJ (53%, <i>p</i> = 0.007) or RYGB (49%, <i>p</i> = 0.003) compared with SG (28%). By multivariable regression, early hypocalcemia was positively&#xa0;associated with parathyroid autotransplantation (odds ratio [OR] 6.36, <i>p</i> = 0.005), and&#xa0;more parathyroid glands removed (OR 1.45, <i>p</i> = 0.03), while higher&#xa0;preoperative calcium&#xa0;was associated with&#xa0;lower&#xa0;odds of hypocalcemia (OR 0.51, <i>p</i> = 0.02). Late hypocalcemia was independently associated with RYGB (OR 2.38, <i>p</i> = 0.01) and GJ (OR 3.1, <i>p</i> = 0.01). The highest rates of early (81%) and late (71%) hypocalcemia were among those with prior nonbariatric GJ who underwent total thyroidectomy. Early hypocalcemia was associated with prolonged length of stay and 30-day readmission.</p> Conclusions <p>Patients with prior GJ or RYGB frequently experience hypocalcemia following cervical procedures, informing preoperative counseling and perioperative management. Preoperative calcium optimization is a potential mitigative strategy warranting further study.</p>

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Hypocalcemia After Cervical Procedures in Patients with a History of Nonbariatric Gastrojejunostomy

  • 期刊论文

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  • 发表日期：

    2025年9月5日

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  • Aviva S. Mattingly,
  • Timothy Kravchenko,
  • Sanjna Chokshi,
  • Cindy Hakim,
  • Jesse E. Passman,
  • Sara Ginzberg,
  • Solomiya Syvyk,
  • Carrie E. Cunningham,
  • Heather Wachtel,
  • Douglas Fraker,
  • Rachel Kelz,
  • Lauren N. Krumeich

摘要

Background

Hypocalcemia is common after cervical procedures. Patients who have undergone Roux-en-Y gastric bypass (RYGB) experience increased risk for post-thyroidectomy hypocalcemia. This association has not been elucidated for nonbariatric operations that bypass the duodenum.

Methods

A multi-institutional retrospective cohort study included patients who underwent parathyroidectomy and/or thyroidectomy with prior sleeve gastrectomy (SG), bariatric RYGB, or nonbariatric gastrojejunostomy (GJ). The primary outcomes were early (≤6 months) and late (>6 months) postoperative hypocalcemia. The secondary outcomes were prolonged length of stay (>24 hours) and 30-day readmission.

Results

A total of 241 patients had prior SG (39%), RYGB (44%), or GJ (17%). Early (54%) and late (41%) hypocalcemia were common. Patients with prior GJ compared with SG had significantly higher rates of early hypocalcemia (64% vs. 44% p = 0.04). The rate of late hypocalcemia was higher in those with prior GJ (53%, p = 0.007) or RYGB (49%, p = 0.003) compared with SG (28%). By multivariable regression, early hypocalcemia was positively associated with parathyroid autotransplantation (odds ratio [OR] 6.36, p = 0.005), and more parathyroid glands removed (OR 1.45, p = 0.03), while higher preoperative calcium was associated with lower odds of hypocalcemia (OR 0.51, p = 0.02). Late hypocalcemia was independently associated with RYGB (OR 2.38, p = 0.01) and GJ (OR 3.1, p = 0.01). The highest rates of early (81%) and late (71%) hypocalcemia were among those with prior nonbariatric GJ who underwent total thyroidectomy. Early hypocalcemia was associated with prolonged length of stay and 30-day readmission.

Conclusions

Patients with prior GJ or RYGB frequently experience hypocalcemia following cervical procedures, informing preoperative counseling and perioperative management. Preoperative calcium optimization is a potential mitigative strategy warranting further study.