Skip to main content Accessibility help
×
Home

Risk factors for post-thyroidectomy haematoma

  • M Perera (a1), L Anabell (a1), D Page (a1), T Harding (a1), N Gnaneswaran (a1) and S Chan (a1) (a2)...

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.

Copyright

Corresponding author

Address for correspondence: Dr Marlon Perera, Department of Surgery, Western Health, Footscray, Victoria, Australia E-mail: marlonlperera@gmail.com

References

Hide All
1Canaris, GJ, Manowitz, NR, Mayor, G, Ridgway, EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526–34
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;266:1945–52
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;393:667–73
4Palestini, N, Tulletti, V, Cestino, L, Durando, R, Freddi, M, Sisti, G et al. Post-thyroidectomy cervical hematoma [in Italian]. Minerva Chir 2005;60:3746
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;28:271–6
6Lee, HS, Lee, BJ, Kim, SW, Cha, YW, Choi, YS, Park, YH et al. Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol 2009;2:72–7
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:CR247–50
8Ozlem, N, Ozdogan, M, Gurer, A, Gomceli, I, Aydin, R. Should the thyroid bed be drained after thyroidectomy? Langenbecks Arch Surg 2006;391:228–30
9Burkey, SH, van Heerden, JA, Thompson, GB, Grant, CS, Schleck, CD, Farley, DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001;130:914–20
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;393:733–7
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;52:3944
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;99:373–9
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, 582–4
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;18:5761
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;36:2497–502
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;136:1236–41
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;140:866–72
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;20:1918–26
19Voutilainen, PE, Haapiainen, RK, Haglund, CH. Ultrasonically activated shears in thyroid surgery. Am J Surg 1998;175:491–3
20Parker, DJ, Krupa, K, Esler, R, Vujovic, P, Bennett, IC. Use of the harmonic scalpel in thyroidectomy. ANZ J Surg 2009;79:476–80
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;81:510–14
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;92:292–4
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;99:688–92
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;84:383–5
25Serpell, JW, Phan, D. Safety of total thyroidectomy. ANZ J Surg 2007;77:1519
26Schwartz, AE, Clark, OH, Ituarte, P, Lo Gerfo, P. Therapeutic controversy: thyroid surgery—the choice. J Clin Endocrinol Metab 1998;83:1097–105
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;240:1825
28Rosenbaum, MA, Haridas, M, McHenry, CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 2008;195:339–43
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;38:879–85
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;206:1097–105
31Shaha, A, Jaffe, BM. Complications of thyroid surgery performed by residents. Surgery 1988;104:1109–14
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;59:257–60
33Agarwal, A, Mishra, SK. Post-thyroidectomy haemorrhage: an analysis of critical factors in successful management. J Indian Med Assoc 1997;95:418–19
34Flynn, MB, Lyons, KJ, Tarter, JW, Ragsdale, TL. Local complications after surgical resection for thyroid carcinoma. Am J Surg 1994;168:404–7
35Morton, RP, Mak, V, Moss, D, Ahmad, Z, Sevao, J. Risk of bleeding after thyroid surgery: matched pairs analysis. J Laryngol Otol 2012;126:285–8
36Matory, YL, Spiro, RH. Wound bleeding after head and neck surgery. J Surg Oncol 1993;53:1719
37Harding, J, Sebag, F, Sierra, M, Palazzo, FF, Henry, JF. Thyroid surgery: postoperative hematoma—prevention and treatment. Langenbecks Arch Surg 2006;391:169–73

Keywords

Risk factors for post-thyroidectomy haematoma

  • M Perera (a1), L Anabell (a1), D Page (a1), T Harding (a1), N Gnaneswaran (a1) and S Chan (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed