Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery?

Leyre, P.; Desurmont, Thibault; Lacoste, L.; Odasso, Chiara; Bouche, Gauthier; Beaulieu, Anthony; Valagier, Alexandre; Charalambous, Charalambos Panayiotou; Gibelin, Hélène; Debaene, B.; Kraimps, Jean‐Louis

doi:10.1007/s00423-008-0362-y

Cited by 126 publications

(133 citation statements)

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“…23 Lee et al noted that nine of their ten cases of post-thyroidectomy haemorrhage occurred in patients with papillary thyroid cancer. 24 On the other hand, a study by Burkey et al 5 and subsequent works 2,4 have suggested that post-thyroidectomy haemorrhage is a low frequency stochastic event that cannot be reliably predicted using preoperative and surgical variables. This observation is in keeping with our findings.…”

Section: Deep Arterial N=2 (14%)mentioning

confidence: 99%

“…[1][2][3] While a variety of factors (eg postoperative hypertension, use of anticoagulants and extent of dissection) have been implicated in increasing the risk of post-thyroidectomy haemorrhage, it is generally considered a low frequency stochastic event, which is difficult to predict. [4][5][6][7] Bleeding deep to the strap muscles is associated with a higher risk of life threatening airway swelling and obstruction, and the risk of post-thyroidectomy haemorrhage is highest in the early hours following surgery. 8 For these reasons, patients traditionally remained in hospital for 72 hours or longer after thyroidectomy.…”

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confidence: 99%

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Patterns, timing and consequences of post-thyroidectomy haemorrhage

Farooq

Nouraei

Kaddour

et al. 2017

annals

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INTRODUCTION Post-thyroidectomy bleeding is a low frequency but potentially life threatening event that is very difficult to predict. Given the increasing drive towards thyroidectomy with same day discharge, this study was conducted with the aim of identifying patterns, timing and consequences of post-thyroidectomy bleeding to assess the feasibility of day-case thyroidectomy. METHODS All patients who underwent a thyroidectomy between 2008 and 2015 at our institution were identified. Patterns, timing and consequences in all those who developed post-thyroidectomy bleeding were studied. RESULTS Of the 805 patients included in the study, 14 required re-exploration for bleeding; 7 (50%) of these within 8 hours of surgery, 6 (43%) between 18 and 30 hours, and 1 (7%) at 49 hours. Just under half (43%) of those with post-thyroidectomy bleeding had thyrotoxicosis. CONCLUSIONS A significant number of postoperative haemorrhages occurred beyond the immediate postoperative period. Same day discharge after thyroidectomy cannot therefore be recommended as a routine practice.

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Section: Deep Arterial N=2 (14%)mentioning

confidence: 99%

mentioning

confidence: 99%

Patterns, timing and consequences of post-thyroidectomy haemorrhage

Farooq

Nouraei

Kaddour

et al. 2017

annals

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“…Lang et al reported 27% bleeding between 6 and 24 h [6]. In a large series, Leyre et al reported start of bleeding beyond 24 hours in 10% [7]. Promberger et al reported that the clinical manifestation of bleeding occurred within the first six and twelve hours in 81% an 88% of the cases [8].…”

Section: -33mentioning

confidence: 99%

“…The source of bleeding was found in about 95% of the cases. Most often the sources were a nameless small vessel ( 34%), followed by diffuse soft tissues bleeding ( 25%), superior pole thyroid vessels ( 13%) and inferior pole vessels (10%) [7,8]. Additionally, two cases with bleeding occurring 13 days after operation were reported [9].…”

Section: -33mentioning

confidence: 99%

A rare case report of a delayed postoperative cervical hematoma after thyroid redo surgery

Dimov¹,

Mutafchiyski²,

Stanimirov³

et al. 2018

Int J Surg Med

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Introduction:A postoperative cervical hematoma is a relatively rare, but potentially life-threatening complication after thyroid surgery. However, few cases with delayed manifestation after discharge of the patient are available in the literature. Case report: A 63-year-old Caucasian woman underwent total thyroidectomy for recurrent benign nodular goitre. She was discharged on the next day in good condition. On the third postoperative day, she was brought to the emergency unconscious with respiratory distress and enormous swelling of the neck. She was reoperated immediately, and postoperative hematoma due to bleeding from a small branch of the left superior thyroid artery was found. Definitive hemostasis was done. She stayed ten days in the ICU on artificial ventilation until the swelling was relieved. Due to signs of infection the wound was opened and treated with negative pressure wound therapy at regular intervals. After extubation, she was found to have phonation and eyesight disorders, fully recovered by conservative treatment in three weeks. The overall length of hospital stay was 41 days, and she was discharged in good condition. Conclusion: Very rarely, a delayed manifestation of postoperative bleeding after thyroid surgery could be seen. In the light of one-day surgery, the real danger is the possible delay of life-saving surgery, and this should always be kept in mind. Unfortunately, as of today, no reliable predictive signs are heralding delayed bleeding. The prompt surgical re-intervention is of paramount importance for the successful outcome. In this case, we successfully managed the infection with negative pressure wound therapy with white foam, thus preventing life-threatening neck phlegmon and mediastinitis.

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“…The causes that are opposed to early discharge are possible bleeding complications, inferior laryngeal nerves palsy and hypocalcemia (11)(12)(13)(14), but unlike the first two which are generally well detectable within the first 24 hours after surgery, the latest one is called into question, as often detectable beyond 24-48 hours after surgery (6,(15)(16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%