Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

Abstract

Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; posthaematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.

THYRAID: a cognitive aid for the management of neck haematoma following thyroid surgery

“…SCOOP, a cognitive aid to support junior medical staff managing post‐thyroidectomy haematoma, was published recently in the UK and has subsequently been included in a systematic review and consensus guideline 11,12 …”

Achieving optimal outcomes in post thyroidectomy haematoma management

“…Post-operative haematoma following thyroid surgery is a potentially fatal complication which fortunately occurs rarely 1 , with a reported incidence of 0.1%-4.3%. 2,3 To ensure the best outcome for any patient suffering this complication, early recognition and immediate management is crucial.…”

Management of haematoma after transoral endoscopic thyroidectomy via vestibular approach

“…We read with great interest the guidelines on the management of haematoma after thyroid surgery [1], and the authors are to be commended. A new technique for thyroid surgery, the transoral endoscopic thyroidectomy via vestibular approach (TOETVA), was reported for the first time in 2016 for selected patient groups [2, 3].…”

“…Because TOETVA uses an oral vestibular approach, the recommendations by Illif et al. regarding SCOOP (skin exposure; cut sutures; open skin; open muscles (superficial and deep layers); pack wound) cannot be applied 1:1 [1]. Specifically, regarding the ‘open skin’ recommendation, there are no skin sutures and so the intact skin has to be incised with a scalpel.…”

“…Specifically, regarding the ‘open skin’ recommendation, there are no skin sutures and so the intact skin has to be incised with a scalpel. Therefore, we have modified the proposed SCOOP approach [1], and offer an alternative for patients with a haematoma after TOETVA which requires urgent evacuation. We recommend marking the skin where the incision for haematoma evacuation should be performed with an indelible marker at the end of surgery.…”