Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Zhimei Chen, Qiyuan Zhao, Jinlei Du, Ya Wang, Rongrong Han, Caijuan Xu, Xiaofang Chen, Min Shu, Zhimei Chen, Qiyuan Zhao, Jinlei Du, Ya Wang, Rongrong Han, Caijuan Xu, Xiaofang Chen, Min Shu

Abstract

Objective: A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients.

Methods: A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate.

Results: The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54.

Conclusions: This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

Keywords: Thyroid; hypocalcaemia; meta-analysis; prevalence; risk factor.

Conflict of interest statement

Declaration of conflicting interests: The authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of eligible studies showing the number of citations identified, retrieved and included in the final meta-analysis.
Figure 2.
Figure 2.
Forest plot of a meta-analysis to evaluate the relationship between female sex and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,,,,,,
Figure 3.
Figure 3.
Forest plot of a meta-analysis to evaluate the relationship between preoperative vitamin D and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,
Figure 4.
Figure 4.
Forest plot of a meta-analysis to evaluate the relationship between hypomagnesaemia and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,
Figure 5.
Figure 5.
Forest plot of a meta-analysis to evaluate the relationship between hypoparathyoidism and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,
Figure 6.
Figure 6.
Forest plot of a meta-analysis to evaluate the relationship between thyroid malignancy and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,,
Figure 7.
Figure 7.
Forest plot of a meta-analysis to evaluate the relationship between central neck dissection and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,
Figure 8.
Figure 8.
Forest plot of a meta-analysis to evaluate the relationship between total thyroidectomy and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,
Figure 9.
Figure 9.
Forest plot of a meta-analysis to evaluate the relationship between central compartment neck dissection and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,,
Figure 10.
Figure 10.
Forest plot of a meta-analysis to evaluate the relationship between modified radical neck dissection and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,
Figure 11.
Figure 11.
Forest plot of a meta-analysis to evaluate the relationship between incidental parathyroidectomy and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,
Figure 12.
Figure 12.
Forest plot of a meta-analysis to evaluate the relationship between substernal multinodular goitre and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,
Figure 13.
Figure 13.
Forest plot of a meta-analysis to evaluate the relationship between thyroiditis and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,
Figure 14.
Figure 14.
Forest plot of a meta-analysis to evaluate the relationship between preoperative calcium level and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,
Figure 15.
Figure 15.
Forest plot of a meta-analysis to evaluate the relationship between preoperative parathyroid hormone and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,
Figure 16.
Figure 16.
Forest plot of a meta-analysis to evaluate the relationship between Graves’ disease and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,
Figure 17.
Figure 17.
Forest plot of a meta-analysis to evaluate the relationship between surgery time and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,
Figure 18.
Figure 18.
Forest plot of a meta-analysis to evaluate the relationship between age and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients. CI, confidence interval.,,,,,,

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