Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-24T09:10:52.478Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors for post-thyroidectomy haematoma

Published online by Cambridge University Press:  21 December 2015

M Perera ,
L Anabell ,
D Page ,
T Harding ,
N Gnaneswaran  and
S Chan
M Perera*
Affiliation:
Department of Surgery, Western Health, Footscray, Australia
L Anabell
Affiliation:
Department of Surgery, Western Health, Footscray, Australia
D Page
Affiliation:
Department of Surgery, Western Health, Footscray, Australia
T Harding
Affiliation:
Department of Surgery, Western Health, Footscray, Australia
N Gnaneswaran
Affiliation:
Department of Surgery, Western Health, Footscray, Australia
S Chan
Affiliation:
Department of Surgery, Western Health, Footscray, Australia Academic Surgery, University of Melbourne, Victoria, Australia
*
Address for correspondence: Dr Marlon Perera, Department of Surgery, Western Health, Footscray, Victoria, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There has been increasing emphasis on performing ‘same-day’ or ‘out-patient’ thyroidectomy to reduce associated costs. However, acceptance has been limited by the risk of potentially life-threatening post-operative bleeding. This study aimed to review current rates of post-operative bleeding in a metropolitan teaching hospital and identify risk factors.

Method:

Medical records of patients undergoing thyroidectomy between January 2007 and March 2012 were reviewed retrospectively. Pre-operative, operative and pathological data, and post-operative complication data, were examined.

Results:

The study comprised 205 thyroidectomy cases. Mean age was 51.6 years (standard deviation = 14.74), with 80 per cent females. Unilateral thyroidectomy was performed in 81 cases (39.5 per cent) and total thyroidectomy was performed in 74 cases (36.1 per cent; 5.3 per cent with concomitant lymph node dissection). Nine patients (4.4 per cent) suffered post-operative bleeding, of which six required re-operation. Analysis showed that post-operative systolic blood pressure of 180 mmHg or greater was associated with post-operative bleeding (p = 0.003, chi-square test).

Conclusion:

Rates of significant post-operative bleeding are consistent with recent literature. Post-operative hypertension, diabetes and high post-operative drain output were identified as independent risk factors on multivariate analysis; when identified, these may be caveats to same-day discharge of thyroidectomy patients.

Keywords

Thyroidectomy; Postoperative Complications; Postoperative Procedures; Adverse Effects; Hematoma; Surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue S1 , January 2016 , pp. S20 - S25
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Canaris, GJ, Manowitz, NR, Mayor, G, Ridgway, EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526–34Google Scholar
2Godballe, C, Madsen, AR, Pedersen, HB, Sorensen, CH, Pedersen, U, Frisch, T et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT head and neck surgery. Eur Arch Otorhinolaryngol 2009;266:1945–52Google Scholar
3Bergenfelz, A, Jansson, S, Kristoffersson, A, Martensson, H, Reihner, E, Wallin, G et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393:667–73Google Scholar
4Palestini, N, Tulletti, V, Cestino, L, Durando, R, Freddi, M, Sisti, G et al. Post-thyroidectomy cervical hematoma [in Italian]. Minerva Chir 2005;60:37–46Google ScholarPubMed
5Rosato, L, Avenia, N, Bernante, P, De Palma, M, Gulino, G, Nasi, PG et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–6CrossRefGoogle Scholar
6Lee, HS, Lee, BJ, Kim, SW, Cha, YW, Choi, YS, Park, YH et al. Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol 2009;2:72–7Google Scholar
7Hurtado-Lopez, LM, Zaldivar-Ramirez, FR, Basurto Kuba, E, Pulido Cejudo, A, Garza Flores, JH, Munoz Solis, O et al. Causes for early reintervention after thyroidectomy. Med Sci Monit 2002;8:CR247–50Google Scholar
8Ozlem, N, Ozdogan, M, Gurer, A, Gomceli, I, Aydin, R. Should the thyroid bed be drained after thyroidectomy? Langenbecks Arch Surg 2006;391:228–30CrossRefGoogle ScholarPubMed
9Burkey, SH, van Heerden, JA, Thompson, GB, Grant, CS, Schleck, CD, Farley, DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001;130:914–20CrossRefGoogle ScholarPubMed
10Leyre, P, Desurmont, T, Lacoste, L, Odasso, C, Bouche, G, Beaulieu, A et al. Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery? Langenbecks Arch Surg 2008;393:733–7CrossRefGoogle ScholarPubMed
11Efremidou, EI, Papageorgiou, MS, Liratzopoulos, N, Manolas, KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52:39–44Google Scholar
12Promberger, R, Ott, J, Kober, F, Koppitsch, C, Seemann, R, Freissmuth, M et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 2012;99:373–9CrossRefGoogle ScholarPubMed
13Snyder, SK, Hamid, KS, Roberson, CR, Rai, SS, Bossen, AC, Luh, JH et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg 2010;210:575–82, 582–4CrossRefGoogle Scholar
14Inabnet, WB, Shifrin, A, Ahmed, L, Sinha, P. Safety of same day discharge in patients undergoing sutureless thyroidectomy: a comparison of local and general anesthesia. Thyroid 2008;18:57–61CrossRefGoogle ScholarPubMed
15Lang, BH, Yih, PC, Lo, CY. A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe? World J Surg 2012;36:2497–502Google Scholar
16Lombardi, CP, Raffaelli, M, Princi, P, Santini, S, Boscherini, M, De Crea, C et al. Early prediction of postthyroidectomy hypocalcemia by one single iPTH measurement. Surgery 2004;136:1236–41Google Scholar
17Chan, WF, Lang, BH, Lo, CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006;140:866–72Google Scholar
18Lang, BH, Ng, SH, Lau, LL, Cowling, BJ, Wong, KP. A systematic review and meta-analysis comparing the efficacy and surgical outcomes of total thyroidectomy between harmonic scalpel versus ligasure. Ann Surg Oncol 2013;20:1918–26CrossRefGoogle ScholarPubMed
19Voutilainen, PE, Haapiainen, RK, Haglund, CH. Ultrasonically activated shears in thyroid surgery. Am J Surg 1998;175:491–3Google Scholar
20Parker, DJ, Krupa, K, Esler, R, Vujovic, P, Bennett, IC. Use of the harmonic scalpel in thyroidectomy. ANZ J Surg 2009;79:476–80Google Scholar
21Chang, LY, O'Neill, C, Suliburk, J, Sidhu, S, Delbridge, L, Sywak, M. Sutureless total thyroidectomy: a safe and cost-effective alternative. ANZ J Surg 2011;81:510–14Google Scholar
22Moumoulidis, I, Martinez Del Pero, M, Brennan, L, Jani, P. Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt. Ann R Coll Surg Engl 2010;92:292–4Google Scholar
23Vasica, G, O'Neill, CJ, Sidhu, SB, Sywak, MS, Reeve, TS, Delbridge, LW. Reoperative surgery for bilateral multinodular goitre in the era of total thyroidectomy. Br J Surg 2012;99:688–92Google Scholar
24Glover, AR, Gundara, JS, Lee, JC, Sywak, MS, Delbridge, LW, Sidhu, SB. Thermal sealing systems with and without tissue divider for total thyroidectomy. ANZ J Surg 2014;84:383–5Google Scholar
25Serpell, JW, Phan, D. Safety of total thyroidectomy. ANZ J Surg 2007;77:15–19Google Scholar
26Schwartz, AE, Clark, OH, Ituarte, P, Lo Gerfo, P. Therapeutic controversy: thyroid surgery—the choice. J Clin Endocrinol Metab 1998;83:1097–105Google Scholar
27Zambudio, AR, Rodriguez, J, Riquelme, J, Soria, T, Canteras, M, Parrilla, P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240:18–25Google Scholar
28Rosenbaum, MA, Haridas, M, McHenry, CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 2008;195:339–43CrossRefGoogle ScholarPubMed
29Emre, AU, Cakmak, GK, Tascilar, O, Ucan, BH, Irkorucu, O, Karakaya, K et al. Complications of total thyroidectomy performed by surgical residents versus specialist surgeons. Surg Today 2008;38:879–85Google Scholar
30Sosa, JA, Mehta, PJ, Wang, TS, Boudourakis, L, Roman, SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg 2008;206:1097–105CrossRefGoogle ScholarPubMed
31Shaha, A, Jaffe, BM. Complications of thyroid surgery performed by residents. Surgery 1988;104:1109–14Google ScholarPubMed
32Martin, L, Delbridge, L, Martin, J, Poole, A, Crummer, P, Reeve, TS. Trainee surgery in teaching hospitals: is there a cost? Aust N Z J Surg 1989;59:257–60Google Scholar
33Agarwal, A, Mishra, SK. Post-thyroidectomy haemorrhage: an analysis of critical factors in successful management. J Indian Med Assoc 1997;95:418–19Google ScholarPubMed
34Flynn, MB, Lyons, KJ, Tarter, JW, Ragsdale, TL. Local complications after surgical resection for thyroid carcinoma. Am J Surg 1994;168:404–7Google Scholar
35Morton, RP, Mak, V, Moss, D, Ahmad, Z, Sevao, J. Risk of bleeding after thyroid surgery: matched pairs analysis. J Laryngol Otol 2012;126:285–8Google Scholar
36Matory, YL, Spiro, RH. Wound bleeding after head and neck surgery. J Surg Oncol 1993;53:17–19CrossRefGoogle ScholarPubMed
37Harding, J, Sebag, F, Sierra, M, Palazzo, FF, Henry, JF. Thyroid surgery: postoperative hematoma—prevention and treatment. Langenbecks Arch Surg 2006;391:169–73Google Scholar