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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(03): e421-e427
DOI: 10.1055/s-0040-1714129
Original Research

Risk Factors and Outcomes of Postoperative Neck Hematomas: An Analysis of 5,900 Thyroidectomies Performed at a Cancer Center

Andre Ywata de Carvalho 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Camila Couto Gomes 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Thiago Celestino Chulam 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Jose Guilherme Vartanian 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Genival Barbosa Carvalho 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Renan Bezerra Lira 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Hugo Fontan Kohler 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
,
Luiz Paulo Kowalski 
1   AC Camargo Cancer Center, São Paulo, SP, Brazil
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Abstract

Introduction Postoperative neck hematoma (PNH) is an uncommon but potentially-lethal complication of thyroid surgery.

Objective To identify the risk factors for postthyroidectomy hematoma requiring reoperation, the timing, the source of the bleeding, the related respiratory distress requiring tracheotomy, and the late outcomes.

Methods We retrospectively analyzed the records of 5,900 consecutive patients submitted to surgery for thyroid diseases at a single institution.

Results In total, PNH occurred in 62 (1.1%) patients. Most cases of bleeding occurred within the first 6 hours after thyroidectomy, but 12.5% of the hematomas were observed after 24 hours. Obvious bleeding points were detected in 58.1% of the patients during the reoperation, with inferior thyroid artery branches and superior thyroid vessels being the most frequent bleeding sources. Only two patients required urgent tracheostomy. There were no hematoma-related deaths. Permanent hypoparathyroidism and recurrent laryngeal nerve injury are more frequent following reoperation for PNH. The factors significantly associated with PNH were: older age, concurrent lymph node dissection, and chronic lymphocytic thyroiditis. Gender, previous neck irradiation, presentation at diagnosis (symptomatic or incidental), substernal goiter, thyroidectomy for hyperthyroidism, prior thyroid surgery, malignant histology, the extent of the surgery (total versus non-total thyroidectomy), the use of energy-based vessel sealing devices, the use of the hemostatic agent Surgicel, and the placement of a surgical drain were not significantly associated with PNH.

Conclusion Hematoma after thyroid surgery is an uncommon complication, but it is related to significant postoperative morbidity. A better understanding of the risk factors and of the time until hematoma formation can help target high-risk patients for preventive measures and closer postoperative observation.

Keywords

thyroid - hematoma - complication - surgery - reoperation


Publication History

Received: 15 November 2019

Accepted: 05 June 2020

Article published online:
30 September 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sun GH, DeMonner S, Davis MM. Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006. Thyroid 2013; 23 (06) 727-733
    CrossrefPubMedSearch in Google Scholar
  • 2 Sørensen KR, Klug TE. Routine outpatient thyroid surgery cannot be recommended. Dan Med J 2015; 62 (02) A5016
    PubMedSearch in Google Scholar
  • 3 Margolick J, Chen W, Wiseman SM. Systematic Review and Meta-Analysis of Unplanned Reoperations, Emergency Department Visits and Hospital Readmission After Thyroidectomy. Thyroid 2018; 28 (05) 624-638
    CrossrefPubMedSearch in Google Scholar
  • 4 Christakis IA, Potylchansky E, Silva AM. et al. Cervical hematoma following an endocrine surgical procedure: The MD Anderson experience. Surgery 2016; 160 (02) 377-383
    CrossrefPubMedSearch in Google Scholar
  • 5 Lang 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 (10) 2497-2502
    CrossrefPubMedSearch in Google Scholar
  • 6 Weiss A, Lee KC, Brumund KT, Chang DC, Bouvet M. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014; 156 (02) 399-404
    CrossrefPubMedSearch in Google Scholar
  • 7 Dehal A, Abbas A, Hussain F, Johna S. Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database. Perm J 2015; 19 (01) 22-28
    CrossrefPubMedSearch in Google Scholar
  • 8 Godballe C, Madsen AR, Pedersen HB. 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 (12) 1945-1952
    CrossrefPubMedSearch in Google Scholar
  • 9 Bergenfelz A, Jansson S, Kristoffersson A. 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 (05) 667-673
    CrossrefPubMedSearch in Google Scholar
  • 10 Liu J, Li Z, Liu S, Wang X, Xu Z, Tang P. Risk factors for and occurrence of postoperative cervical hematoma after thyroid surgery: A single-institution study based on 5156 cases from the past 2 years. Head Neck 2016; 38 (02) 216-219
    CrossrefPubMedSearch in Google Scholar
  • 11 Campbell MJ, McCoy KL, Shen WT. et al. A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery 2013; 154 (06) 1283-1289 , discussion 1289–1291
    CrossrefPubMedSearch in Google Scholar
  • 12 Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001; 130 (06) 914-920
    CrossrefPubMedSearch in Google Scholar
  • 13 Suzuki S, Yasunaga H, Matsui H, Fushimi K, Saito Y, Yamasoba T. Factors Associated With Neck Hematoma After Thyroidectomy: A Retrospective Analysis Using a Japanese Inpatient Database. Medicine (Baltimore) 2016; 95 (07) e2812
    CrossrefPubMedSearch in Google Scholar
  • 14 Promberger R, Ott J, Kober F. et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 2012; 99 (03) 373-379
    CrossrefPubMedSearch in Google Scholar
  • 15 Fan C, Zhou X, Su G. et al. Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis. BMC Surg 2019; 19 (01) 98
    CrossrefPubMedSearch in Google Scholar
  • 16 Liu J, Sun W, Dong W. et al. Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol 2017; 176 (05) 591-602
    CrossrefPubMedSearch in Google Scholar
  • 17 Calò PG, Pisano G, Piga G. et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience. Ann Ital Chir 2010; 81 (05) 343-347
    PubMedSearch in Google Scholar
  • 18 Agarwal A, Agarwal S, Tewari P. et al. Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region. World J Surg 2012; 36 (04) 755-760
    CrossrefPubMedSearch in Google Scholar
  • 19 Quimby AE, Wells ST, Hearn M, Javidnia H, Johnson-Obaseki S. Is there a group of patients at greater risk for hematoma following thyroidectomy? A systematic review and meta-analysis. Laryngoscope 2017; 127 (06) 1483-1490
    CrossrefPubMedSearch in Google Scholar
  • 20 Hardman JC, Smith JA, Nankivell P, Sharma N, Watkinson JC. Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre. Eur Arch Otorhinolaryngol 2015; 272 (06) 1503-1508
    CrossrefPubMedSearch in Google Scholar
  • 21 Li YJ, Wang YZ, Yi ZB, Chen LL, Zhou XD. Comparison of Completion Thyroidectomy and Primary Total Surgery for Differentiated Thyroid Cancer: A Meta-Analysis. Oncol Res Treat 2015; 38 (10) 528-531
    CrossrefPubMedSearch in Google Scholar
  • 22 Garas G, Okabayashi K, Ashrafian H. et al. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid 2013; 23 (09) 1138-1150
    CrossrefPubMedSearch in Google Scholar
  • 23 Siu JM, McCarty JC, Gadkaree S. et al. Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations. JAMA Surg 2019; 154 (11) e193146
    CrossrefPubMedSearch in Google Scholar
  • 24 Ecker T, Carvalho AL, Choe JH, Walosek G, Preuss KJ. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques--a meta-analysis. Otolaryngol Head Neck Surg 2010; 143 (01) 17-25
    CrossrefPubMedSearch in Google Scholar
  • 25 Yao HS, Wang Q, Wang WJ, Ruan CP. Prospective clinical trials of thyroidectomy with LigaSure vs conventional vessel ligation: a systematic review and meta-analysis. Arch Surg 2009; 144 (12) 1167-1174
    CrossrefPubMedSearch in Google Scholar
  • 26 Pons Y, Gauthier J, Ukkola-Pons E. et al. Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy. Otolaryngol Head Neck Surg 2009; 141 (04) 496-501
    CrossrefPubMedSearch in Google Scholar
  • 27 Hua N, Quimby AE, Johnson-Obaseki S. Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161 (05) 770-778
    CrossrefPubMedSearch in Google Scholar
  • 28 Amit M, Binenbaum Y, Cohen JT, Gil Z. Effectiveness of an oxidized cellulose patch hemostatic agent in thyroid surgery: a prospective, randomized, controlled study. J Am Coll Surg 2013; 217 (02) 221-225
    CrossrefPubMedSearch in Google Scholar
  • 29 Sanabria A, Carvalho AL, Silver CE. et al. Routine drainage after thyroid surgery--a meta-analysis. J Surg Oncol 2007; 96 (03) 273-280
    CrossrefPubMedSearch in Google Scholar
  • 30 Woods RS, Woods JF, Duignan ES, Timon C. Systematic review and meta-analysis of wound drains after thyroid surgery. Br J Surg 2014; 101 (05) 446-456
    CrossrefPubMedSearch in Google Scholar
  • 31 Smith RB, Coughlin A. Thyroidectomy Hemostasis. Otolaryngol Clin North Am 2016; 49 (03) 727-748
    CrossrefPubMedSearch in Google Scholar
  • 32 Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 2013; 154 (06) 1346-1352 , discussion 1352–1353
    CrossrefPubMedSearch in Google Scholar