Effectiveness of a multifaceted intervention on reducing non-guideline-concordant prescribing of calcium and vitamin D analogues after total thyroidectomy

Background Postoperative hypocalcemia is a common complication of total thyroidectomy. Due to a lack of standardized perioperative management protocols, there is often a wide variation in clinical practice, resulting in non-guideline conforming calcium and vitamin D analogue (NGC-CaVD) prescribing. This can lead to issues with patient safety and recovery. Objective To determine if a multi-faceted intervention could reduce NGC-CaVD after total thyroidectomy, assess safety outcomes, and identify factors associated with inappropriate prescribing. Methods This retrospective observational cohort study included 629 adults undergoing total thyroidectomy (322 pre-intervention, 307 post-intervention). The intervention bundle included: (1) developing an institutional guideline, (2) conducting staff education, (3) pharmacist-led medication reviews with structured recommendations, (4) medication reconciliation, and (5) collaborative rounds. The primary outcome was the rate of NGC-CaVD. Safety outcomes included the incidence of symptomatic hypocalcemia and length of hospital stay. Results The multifaceted intervention significantly reduced the overall NGC-CaVD rate from 45.96% in the pre-intervention group to 23.45% in the post-intervention group ( p < 0.01). Results Improvements were also seen in specific areas: inappropriate calcium preparation selection (8.07% versus 2.93%, p < 0.01), calcium dosage (23.91% versus 11.73%, p < 0.01), vitamin D analogue dosage (30.75% versus 6.84%, p < 0.01), and delayed IV to oral switch (4.97%–1.95%, p = 0.04). The per-group NGC-CaVD cost decreased from RMB 17.34 (IQR: 0, 19.56) to RMB 4.42 (IQR: 0, 0) (p < 0.01). The main barrier influencing NGC-CaVD was physician-related factors, including excessive concern for the risk of postoperative hypocalcemia. The rate of symptomatic hypocalcemia remained unchanged (6.83%–5.86%, p = 0.62) as did mean hospital stay (7.16 ± 2.70 days vs. 7.21 ± 2.65 days, p = 0.75). Multivariable analysis identified that longer surgical times (adjusted OR: 1.012, 95% CI: 1.007–1.035, p = 0.023) and longer lengths of stay (adjusted OR: 1.128, 95% CI: 1.008–1.262, p = 0.036) were independent predictors of NGC-CaVD. Conclusion The implementation of a multi-faceted intervention improved guideline adherence for postoperative prescribing of calcium and vitamin D analogues without affecting symptomatic hypocalcemia and length of stay. Additionally, the model provides a framework for the standardization of post-thyroidectomy hypocalcemia management and the improved appropriateness of medication prescribing.