Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol (p< 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p= 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

Head and neck carcinomas

To find out the effect of concomitant chemo-radiotherapy on the survival of patient, to assess the, toxicity of different treatments modalities and the effect of age, sex and bulk or tumour on survival. This study was carried out in the Department of Radiology and Oncology, Nishtar Hospital, Multan from January 2007 to December 2009. A total of 100 patients with biopsy proven diagnosis of squamous cell carcinoma of head and neck were included in the study. All patients were in advanced stage. All patients underwent complete clinical examination which includes physical examination, indirect/direct laryngoscopy. Patients were randomized into three groups i.e. group-A:- Induction chemotherapy with cisplatin and 5-FU infusion for 3 days followed by radiotherapy. Thirty five patients were included in this group. Group-B:- Radiotherapy alone with cobalt 60 - 6600 cGy in 6-7 weeks, Thirty three patients were included in this group. Group-C:- concomitant chemo-radiotherapy. Thirty two patients were included in this group. Out of 100 patients, 60 were male and remaining 40 were females. The mean age of the patients included in the study was 52 years, range being 22-60 years. The patients of head and neck cancer in the study had different sites of involvement. The patients presented with, various symptoms such as pain, swelling, ulcer, bleeding, dysphagia, hoarseness of voice etc. No patients had early stage disease. All the patients in this study had the experience of nausea and vomiting, it was more marked in patients having radiotherapy, either alone or concomitant with chemotherapy. The patients having concomitant chemo-radiotherapy of group-C also had diarrhea as a side effect. The effect on the liver function test was more pronounced in patients of group-A. The renal function was seen to alter more in patients receiving chemotherapy with cisplatin, whether as induction or as a concomitant to radiotherapy. Concomitant chemotherapy followed by radiotherapy and the standard radiotherapy alone

Concomitant chemoradiotherapy with cisplatin and 5-flourouracil in locally advanced unresectable head and neck carcinomas

To see the effect of concomitant chemo-radiotherapy on the survival of patient, to assess the toxicity of different treatment arms and the effect of age, sex and bulk or tumour on survival and compare the literature; Radiotherapy Department, Nishtar Hospital, Multan. This study was conducted in the Radiotherapy Department, Nishtar Hospital, Multan during the period of 2 years from 1998 to 2000. A total of 200 patients were included in the study. Patients were randomized into three following groups. Out of 130 patients, 83 were males and the remaining 47 were females. The male to female ratio being 1.8:1. The mean age of the patients included in the study was 52 years, range being 22-80 years the patients of head and neck cancer in the trial had different sites of involvement. In the trial the patients presented with various symptoms such as pain, swelling, ulcer, bleeding, dysphagia, dyspnea, hoarseness of voice and nasal obstruction etc. No patient had early stage disease. All the patients in the trial had the experience of nausea and vomiting, it was more marked in patients having radiotherapy; either alone or in concomitant with chemotherapy. Concomitant chemo-radiotherapy in locally advanced, unresectable head and neck carcinoma is statistically superior to induction chemotherapy followed by radiotherapy and the standard radiotherapy alone