Outpatient parathyroid surgery and the differences seen in the morbidly obese

This prospective study examined rapid patient discharge after routine parathyroidectomy to identify differences between morbidly obese and non-morbidly obese patients. The efficacy of supplemental calcium in preventing postoperative hypocalcemia was also assessed.

Between March 2003 and June 2004, 842 patients with primary hyperparathyroidism underwent outpatient parathyroid surgery. Morbid obesity was defined as 100 pounds above ideal body weight and/or body mass index greater than 39.

Fifty-one (6.1%) patients were morbidly obese (mean, 261 lbs; body mass index=45) compared with 791 non-morbidly obese patients (mean, 172 lbs; body mass index=28, P<.001). Morbidly obese patients were more likely to require conversion of laryngeal masked airway to endotracheal intubation (P<.05). Incision length, total operative times, and the total time spent in the post-anesthesia care unit were longer for morbidly obese patients (all, P<.05). Of the 842 patients, only four, all non-morbidly obese, spent the night after their operation. No postoperative untoward events occurred in either group.

Immediate discharge after routine parathyroid surgery is extremely safe for nearly all patients although morbid obesity is associated with a longer operation, a more difficult airway, and a longer stay in the recovery room.