Management of postoperative hemorrhage following thyroid surgery

Abstract

The incidence of postoperative hemorrhage following thyroid surgery stands at 1%-2 %. This low incidence contrasts with the significant potential complications of postoperative hemorrhage. Influencing factors and measures mentioned in the literature and own studies are discussed. Although an improvement in the postoperative hemorrhage rate was to be expected indirectly due to the increasing use of coagulation-relevant medication, there has been neither an increase in incidence nor a reduction in resultant complications, including primarily recurrent vocal cord paresis, tracheotomy and mortality. Factors that influence surgical success include a meticulous technique and caution, as well as ensuring intensive and qualified postoperative monitoring for a minimum of 4-6 h, thereby permitting immediate revision surgery at any time.

Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

“…In these, bleeding rates range from 0.3 to 4.4% according to surgeon category. Equal distribution of postoperative hemorrhage between surgeon categories and experience is demonstrated by Bergamaschi et al [ 28 ] (ELIII, RGD), Wang et al [ 29 ] (ELIII, RGD), Loyo et al [ 7 ], Perera et al [ 30 ] (ELIII, RGD), Lorenz et al [ 31 ] (ELIII, RGC), Gurrado et al [ 32 ] (ELIII, RGD), and Meltzer et al [ 33 ] (ELII, RGC) (Table 5 ). None of these studies specifies outcomes or consequences in the event of postoperative hemorrhage.…”

Neck Circumference Measurement for Surveillance and Early Detection of Hemorrhage After Thyroidectomy

“…[1][2][3] Hemorrhage may increase cervical compartment pressure, which has been associated with life-threatening respiratory conditions and hypoxemic brain damage. 1,[4][5][6][7][8] A number of risk factors for postthyroidectomy hemorrhage have been identified, including older age , male sex, antithrombotic agent use, hyperthyroidism, malignant disease, and previous thyroid surgery. [1][2][3][4]9 Despite the use of hemostatic agents and vessel sealing devices, the incidence of postthyroidectomy hemorrhage remains unchanged.…”

“…1,[4][5][6][7][8] A number of risk factors for postthyroidectomy hemorrhage have been identified, including older age , male sex, antithrombotic agent use, hyperthyroidism, malignant disease, and previous thyroid surgery. [1][2][3][4]9 Despite the use of hemostatic agents and vessel sealing devices, the incidence of postthyroidectomy hemorrhage remains unchanged. 1,2,4,8,[10][11][12][13] Therefore, accurate and efficient hemostasis continues to be essential for the prevention of bleeding complications.…”

“…[1][2][3][4]9 Despite the use of hemostatic agents and vessel sealing devices, the incidence of postthyroidectomy hemorrhage remains unchanged. 1,2,4,8,[10][11][12][13] Therefore, accurate and efficient hemostasis continues to be essential for the prevention of bleeding complications.…”

“…Because there is no reliable method to anticipate postthyroidectomy hemorrhage, meticulous postoperative surveillance is the only option for early detection of postthyroidectomy hemorrhage and its associated secondary complications. 1,4,8,14 Routine postoperative patient surveillance is based on clinical observation. However, clinical observation and the use of drains are unreliable indicators for early detection of postthyroidectomy hemorrhage.…”