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Postoperative bleeding after thyroid surgery remains a potentially lethal complication. Outpatient thyroidectomy is an increasing trend in the high volume centers. There is a need to identify risk factors for postoperative bleeding in order to select proper patients for outpatient thyroidectomy. This study aimed to investigate this issue using a national population-based register.
A nested case-control study on patients registered in the Swedish national register for endocrine surgery (SQRTPA) was performed. Patients with postoperative bleeding were matched 1:1 by age and gender to controls. Additional information on cases and controls was obtained from attending surgeons using a questionnaire. Risk factors for postoperative bleeding were evaluated with logistic regression and are presented as odds ratios (ORs) with 95% confidence intervals (CIs). The time of bleeding in relation to surgery was also investigated.
There were 9494 operations, and 174 (1.8%) of them involved postoperative bleeding. In the whole cohort, patients with postoperative bleeding were older, 58 (46–69) vs. 49 (37–62) years, than patients without, p < 0.01. Male patients had a higher risk of bleeding, OR 2.18 (95% CI 1.58–2.99). In the case-control cohort, drain was an independent risk factor for bleeding, OR 1.64 (1.05–2.57). Two-thirds of patients bled within 6 h after surgery. The incidence of bleeding after 24 h was 10%.
High age, male gender, and drain are independent risk factors for bleeding after thyroid surgery. Even with careful patient selection, prolonged observation might be necessary in thyroid surgery.
Abboud B, Sleilaty G, Rizk H et al (2012) Safety of thyroidectomy and cervical neck dissection without drains. Can J Surg 55:199–203 CrossRef
Bononi M, Amore Bonapasta S, Vari A, Scarpini M, de Cesare A, Miccini M, Meucci M, Tocchi A (2010) Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 32:1173–1177 CrossRef
Goncalves Filho J, Kowalski LP (2005) Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 132:490–494 CrossRef
Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck's Arch Surg 393:667–673 CrossRef
Weiss A, Lee KC, Brumund KT, Chang DC, Bouvet M (2014) Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 156:399–404 CrossRef
Christou N, Mathonnet M (2013) Complications after total thyroidectomy. J Visc Surg 150:249–256 CrossRef
Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR (2001) Reexploration for symptomatic hematomas after cervical exploration. Surgery 130:914–920 CrossRef
Lee HS, Lee BJ, Kim SW, Cha YW, Choi YS, Park YH, Lee KD (2009) Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol 2:72–77 CrossRef
Sun GH, DeMonner S, Davis MM (2013) Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006. Thyroid 23:727–733 CrossRef
Tuggle CT, Roman S, Udelsman R, Sosa JA (2011) Same-day thyroidectomy: a review of practice patterns and outcomes for 1,168 procedures in New York state. Ann Surg Oncol 18:1035–1040 CrossRef
Lang BH, Yih PC, Lo CY (2012) A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe? World J Surg 36:2497–2502 CrossRef
Farooq MS, Nouraei R, Kaddour H, Saharay M (2017) Patterns, timing and consequences of post-thyroidectomy haemorrhage. Ann R Coll Surg Engl 99:60–62 CrossRef
Khadra H, Mohamed S, Hauch A, Carter J, Hu T, Kandil E (2017) Safety of same-day thyroidectomy: meta-analysis and systematic review. Gland Surg 6:292–301 CrossRef
Terris DJ, Snyder S, Carneiro-Pla D, Inabnet WB 3rd, Kandil E, Orloff L, Shindo M, Tufano RP, Tuttle RM, Urken M, Yeh MW, American Thyroid Association Surgical Affairs Committee Writing Task Force (2013) American Thyroid Association statement on outpatient thyroidectomy. Thyroid 23:1193–1202
Campbell MJ, McCoy KL, Shen WT et al (2013) A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery 154:1283–1289 discussion 1289-1291 CrossRef
Basques BA, Bohl DD, Golinvaux NS et al (2014) Factors predictive of increased surgical drain output after anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 39:728–735 CrossRef
Rosenbaum MA, Haridas M, McHenry CR (2008) Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 195:339–343 discussion 343 CrossRef
- Evaluating risk factors for re-exploration due to postoperative neck hematoma after thyroid surgery: a nested case-control study
Farhad Allahyar Salem
C. I. Lundgren
- Springer Berlin Heidelberg
Langenbeck's Archives of Surgery
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
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