Introduction
Methods
Study design
Setting
Participants
Variables
Data collection and analysis
Results
Characteristics | Reoperation for bleeding | p value | |
---|---|---|---|
Yes (25) | No (1888) | ||
Age, median (i.q.r.) | 52 (35) | 53 (26) | 0.986 |
Gender | |||
Female | 18 (1.2%) | 1436 (98.8%) | 0.639 |
Male | 7 (1.5%) | 452 (98.5%) | |
Primary organ of surgery | |||
Thyroid | 23 (1.8%) | 1230 (98.2%) | 0.017 |
Parathyroid | 2 (0.3%) | 611 (99.7%) | |
Both thyroid and parathyroid | 0 (0%) | 47 (100%) | |
Consultants | |||
A | 13 (1.5%) | 840 (98.5%) | 0.255 |
B | 8 (0.9%) | 874 (99.1%) | |
C | 4 (2.6%) | 147 (97.4%) | |
D | 0 (0%) | 27 (100%) |
Characteristics | Reoperation for bleeding | p value | |
---|---|---|---|
Yes (25) | No (197) | ||
Index procedure | |||
TT | 16 (64.0%) | 60 (30.5%) | 0.006 |
HT | 7 (28.0%) | 68 (34.5%) | |
Parathyroidectomy | 2 (8.0%) | 66 (33.5%) | |
Others | 3 (1.4%) | 3 (1.5%) | |
Neck dissection | |||
Yes | 2 (8.0%) | 15 (7.6%) | 1.000 |
No | 23 (92.0%) | 182 (92.4%) | |
Re-do surgery | |||
Yes | 1 (4.0%) | 14 (7.1%) | 1.000 |
No | 24 (96.0%) | 183 (92.9%) | |
Drain usec | |||
Yes | 3 (12.5%) | 16 (8.1%) | 0.442 |
No | 21 (87.5%) | 181 (91.9%) | |
Any blood-thinning drugs or clotting disorderc | |||
Yes | 2 (8.3%) | 24 (12.2%) | 0.747 |
No | 22 (91.7%) | 173 (87.8%) | |
RLN palsyc | |||
None | 20 (95.2%) | 177 (94.7%) | 0.699 |
Transient | 0 (0%) | 4 (2.1%) | |
Permanent | 1 (4.8%) | 6 (3.2%) | |
Wound infection | |||
Yes | 0 (0%) | 2 (1.0%) | 1.000 |
No | 25 (100%) | 195 (99.0%) | |
Hypoparathyroidismc | |||
None | 16 (84.2%) | 168 (92.3%) | 0.184 |
Transient | 1 (5.3%) | 9 (4.9%) | |
Long term | 2 (10.5%) | 5 (2.7%) | |
Significant complication | |||
None | 21 (84.0%) | 174 (88.3%) | 0.422 |
Transienta | 1 (4.0%) | 12 (6.1%) | |
Long termb | 3 (12.0%) | 11 (5.6%) | |
BMI, median (i.q.r.) | 27 (24-29) | 27 (23-31) | 0.848 |
Length of stay after surgery, days, median (i.q.r.) | 3 (2-3) | 1 (1-2) | 0.001 |
Management characteristics | n (%) |
---|---|
Time bleeding identified | |
In theatre | 6/25 (24) |
After leaving theatre (≤ 6 h) | 17/25 (68) |
6–24 h post-operative | 1/25 (4) |
> 24 h | 1/25 (4) |
Neck suture removed prior to theatrea | |
Yes | 6/19 (31.6) |
No | 11/19 (57.9) |
Unknown | 2/19 (10.5) |
Steroids givenb | |
Yes | 12/19 (63.2) |
No | 6/19 (31.6) |
NK | 1/19 (5.3) |
Bleeding pointsc | |
Pyramidal lobe vessel | 1 (4) |
Strap muscles/sternocleidomastoid | 3 (12) |
Thyroid bed | 2 (8) |
Inferior thyroid artery/branch | 3 (12) |
Cricothyroid junction | 2 (8) |
Anterior jugular vein | 1 (4) |
Superior pole vessel | 3 (12) |
Superior thyroid vein | 1 (4) |
Generalised ooze | 1 (4) |
Ligament of Berry | 1 (4) |
No specific bleeding point | 9 (36) |
Imaging done | |
Ultrasound neckb | 1/25 (4) |
No imaging | 24/25 (96) |
Drain use following washout | |
Yes | 18/25 (72.0) |
No | 7/25 (28.0) |
Blood transfusion | |
Yes | 1/25 (4.0) |
No | 24/25 (96.0) |
HDU care after surgery | |
Yes | 8/25 (32.0) |
No | 17/25 (68.0) |
Discussion
Incidence and risk factors for bleeding after thyroid and/or parathyroid surgery
Prevention of bleeding after thyroid and/or parathyroid surgery
Parameters | |
---|---|
I | |
T | Time—wait a few minutes |
S | Systolic blood pressure to be > 100 mm Hg at time of closure |
R | Relieve neck extension—either by deflating bag under shoulders, removing sand bag, or flexing the neck |
E | |
D | |
Fred | Flaps—evaluation of bleeding under subplatysmal flaps prior to closure |