Predictors and Consequences of Hematoma After Thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Program Database Analysis

Mahoney, Reid C.; Vossler, John D.; Woodruff, Stacey; Murayama, Kenric M.

doi:10.1016/j.jss.2020.11.081

Cited by 10 publications

(13 citation statements)

References 6 publications

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“…The available data in this review is not sufficient for an analysis that can determine whether there is a correlation between the use of haemostatic aids and PTB. Mahoney et al reported that the use of energy devices for haemostasis during surgery was protective of PTB [ 43 ]. Therefore, energy-based devices and topical biological adhesives cannot be ruled out as confounding factors.…”

Section: Discussionmentioning

confidence: 99%

“…Quimby et al found Graves disease to be the only indication for patients at increased risk of PTB [ 46 ]. In 2021, Mahoney et al reported that male gender, hypertension, diabetes and bleeding disorders were independent risk factors for PTB [ 43 ]. Another recent study from 2021 suggests that a risk score for PTB could be calculated based on two preoperative criteria; sex and anticoagulant treatment, to identify patients for which an outpatient setting is inappropriate [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite a lack of international guidelines for outpatient hemithyroidectomy, the American Thyroid Association has developed a guideline for selecting patients for outpatient thyroidectomy using a combination of the following factors: American Society of Anesthesiologists (ASA) score, patient understanding/capabilities, and home/geographical environment [45]. Many different studies have tried to identify factors associated with a higher PTB risk [4,40,[42][43][44]46]. Lang et al found previous thyroid surgery and the size of the dominant nodule to be independent risk factors [44], whilst Godballe et al identified age, male gender, malignant histology and extent of surgery (total thyroidectomy versus hemithyroidectomy) as independent risk factors for PTB [40].…”

Section: Selection Criteriamentioning

confidence: 99%

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Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

Jeppesen

Moos

Holm

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose After thyroid surgery, the overriding concern is the risk of post-thyroid bleeding (PTB). This systematic review and meta-analysis aimed to assess the safety of hemithyroidectomy in an outpatient setting compared to an inpatient setting. The objectives were to (1) find the proportion of PTB in patients scheduled for outpatient hemithyroidectomy, (2) examine if outpatient hemithyroidectomy is clinically safe compared to an inpatient setting and (3) evaluate which selection criteria are most relevant for hemithyroidectomy in an outpatient setting. Methods A systematic review was conducted using the following databases: MEDLINE (Ovid), EMBASE (Ovid) and the Cochrane Library from inception until September 2021. We included studies reporting on PTB of patients after hemithyroidectomy in an outpatient setting. The risk of bias was assessed using the Newcastle-Ottawa tool. The results were synthesised using Bayesian meta-analysis. Certainty in evidence was assessed using the GRADE approach. Results This review included 11 cohort studies and 9 descriptive studies reporting solely on outpatients resulting in a total of 46,866 patients. PTB was experienced by 58 of the 9025 outpatients (0.6%) and 415 of the 37,841 inpatients (1.1%). There was no difference between the PTB rate of outpatients and inpatients (RR 0.715 CrI [0.396–1.243]). The certainty of the evidence was very low due to the high risk of bias. Conclusion The risk of PTB in an outpatient setting is very low, and outpatient hemithyroidectomy should be considered clinically safe. The most relevant selection criteria to consider in outpatient hemithyroidectomy are (1) relevant comorbidities and (2) psycho/-social factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Selection Criteriamentioning

confidence: 99%

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Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

Jeppesen

Moos

Holm

et al. 2022

Eur Arch Otorhinolaryngol

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“…Post thyroidectomy hemorrhage is a rare but potential life-threatening complication (1)(2)(3)(4)(5). Although cases of hypoxemic brain damage and death are exceptional events, bleeding complications are associated with an increased risk for additional morbidity (2,(5)(6)(7). Several risk factors for post thyroidectomy hemorrhage have been identified, however, the rates for bleeding complications in thyroid surgery of 0.3-4% have not changed over the past decades (2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

Wirth¹,

Schardey²,

Bonleitner³

et al. 2022

Gland Surg

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Background: Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model.Methods: A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated.Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure.Results: With an increase in cervical compartment pressure apnea could be detected in all experiments.A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg.Conclusions: Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.

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“…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.…”

mentioning

confidence: 99%

Achieving optimal outcomes in post thyroidectomy haematoma management

Yeung

2022

ANZ Journal of Surgery

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Predictors and Consequences of Hematoma After Thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Program Database Analysis

Cited by 10 publications

References 6 publications

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model

Achieving optimal outcomes in post thyroidectomy haematoma management

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