Application of optimized postoperative drainage pressure combined with parathyroid function monitoring in enhanced recovery after surgery for thyroid cancer: A prospective randomized controlled study

Abstract

Background: Postoperative drainage management and hypocalcemia monitoring are critical factors influencing enhanced recovery after surgery (ERAS) following thyroidectomy. This study aimed to evaluate the effects of different drainage pressures on postoperative drainage volume and hospitalization duration, and to explore the predictive value of parathyroid hormone (PTH) levels for hypocalcemia. The goal was to develop a multidimensional ERAS strategy for thyroid cancer patients.

Methods: This prospective randomized controlled trial enrolled 211 patients undergoing thyroidectomy. Participants were randomly allocated into three groups based on drainage pressure. Postoperative drainage volume, hospitalization duration, and complications were recorded. For patients undergoing total thyroidectomy, PTH and serum calcium levels were measured postoperatively. The optimal PTH cut-off value was determined using receiver operating characteristic curve analysis.

Results: The low-pressure group exhibited significantly reduced postoperative drainage volume on day 1 (6.54 ± 9.53 mL) compared to the medium- and highpressure groups (34.07 ± 19.05 mL and 32.41 ± 20.72 mL). Drainage removal time (1.06 ± 0.23 days) and hospitalization duration (1.26 ± 0.47 days) were also shorter in the low-pressure group. A postoperative 2-h PTH level ≤ 6.985 pg/mL effectively predicted hypocalcemia (sensitivity 79.4%, specificity 91.0%). The combined ERAS protocol further reduced hospitalization duration and significantly lowered postoperative Visual Analog Scale scores (0.85 ± 0.75) without increasing complication rates.

Conclusion: Low-pressure drainage reduces postoperative drainage volume and accelerates recovery in thyroid cancer patients. A 2-h postoperative PTH level ≤ 6.985 pg/mL serves as a reliable predictor for hypocalcemia. The combined strategy of optimized drainage pressure and PTH monitoring provides a safe and effective ERAS pathway for thyroid surgery.

Keywords

enhanced recovery after surgery (ERAS) / hypocalcemia / parathyroid hormone / postoperative drainage pressure / thyroid cancer

RIGHTS & PERMISSIONS

The Author(s). Eye & ENT Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.