Risk Factors for Neck Hematoma after Thyroid or Parathyroid Surgery: Ten-Year Analysis of the Nationwide Inpatient Sample Database

Dehal, Ahmed; Abbas, Ali; Hussain, Farabi; Johna, Samir

doi:10.7812/tpp/14-085

Cited by 48 publications

(39 citation statements)

References 39 publications

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“…8,9 While patient comorbidities or the extent of surgery required may make outpatient surgery a less viable option for some, specific data regarding risk factors for POH are sparse. 10,11 If concern for POH is the main reason for avoidance of same-day surgery, better data are needed to help clarify which patients may in fact be high risk for POH and thus justify observation.…”

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confidence: 99%

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Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures

et al. 2016

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Purpose Antiplatelet and/or anticoagulant medication use is common. Abstinence a week before surgery may still result in altered hemostasis. The study aim was to report on perioperative antiplatelet and anticoagulant use in thyroidectomy and parathyroidectomy patients, and to determine the association with postoperative hematoma (POH) rates. Methods Retrospective review of a prospective endocrine surgery database was performed. Procedure extent was defined as unilateral, bilateral, or extensive. Antiplatelets were categorized as none, 325 mg aspirin (ASA), <325 mg ASA, clopidogrel, or other. Anticoagulants were categorized as none, oral, or injectable. Results A total of 4514 patients were identified. POH developed in 22 patients (0.5 %). Rates were similar between age, gender, and reoperative status. POH were seven times more common after thyroidectomy (0.8 vs. 0.1 %, p < 0.01). Unilateral procedures had lower POH rates than bilateral or extensive (0.1 vs. 0.9 vs. 0.8 %, p < 0.01). POH rates in patients receiving 325 mg ASA (0.8 %) or clopidogrel (2.2 %) were much higher than patients not receiving antiplatelets (0.5 %) or receiving <325 mg ASA (0.1 %, p = 0.04). Oral anticoagulants (2.2 %) and injectable anticoagulants (10.7 %) had much higher POH rates than patients not receiving anticoagulants (0.4 %, p < 0.01). Target organ, patient gender, procedure extent, antiplatelet use, and anticoagulant use were included on logistic regression to determine association with POH. Bilateral procedures, thyroidectomy, clopidogrel, oral, and injectable anticoagulants were all independently associated with POH. Conclusions POH occur more frequently after thyroidectomy and during bilateral procedures. Patients requiring clopidogrel or any anticoagulant coverage are at much higher risk for POH. These higher-risk patients should be considered for observation to ensure prompt POH recognition and intervention.

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“…While the risk of continued therapy has been explored in other surgical specialties, the impact during thyroid and parathyroid procedures is unknown. 11,14–19 …”

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Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures

et al. 2016

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“…A large multi-institutional international study conducted on over 200 hematomas showed that this complication is associated with the use of a drain, or Graves' disease, antiplatelet/anticoagulation medications and large goiters. Moreover, the Authors affirm that a residual thyroid parenchima, that can be found after hemithyroidectomy or subtotal thyroidectomy, can increase the risk of bleeding (42,43). These findings could lead to a more accurate selection of patients proposed for short stay surgery.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 95%

“…Although the incidence of the definitive hypoparathyroidism decreases respectively to 6,1% and 11,9% for the first-time and the "redo" surgery ones, these values should be considered on the whole high and it should worry in case of early discharge (9). As the hypocalcaemia is the most common morbidity associated with thyroid surgery, it should be the more prominent reason for the decision concerning the time of the discharge, but even the compressive hematoma, although rare, plays an important role in this decisionmaking, since it is a life threatening complication (12,13). Moreover, the inferior laryngeal nerve palsy causes respiratory compromise only if bilateral (8,9,14).…”

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23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients

Raspanti¹,

Porrello²,

Augello³

et al. 2017

GHIR

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“…Several risk factors for PCH have been described in the literature such as advanced age, male gender, smokers, presence of chronic diseases, anticoagulant or antiaggregant therapy, significant resections or reinterventions substernal thyroidectomy, large dominant nodule, inflammatory thyroid diseases, thyrotoxicosis, use of drains, lymph node dissection, parathyroidectomy, [6,[10][11][12]. According to literature, surgeon's experience is also of great value, and rates between 2% and 14% were reported [4], whereas others reported up to the sevenfold difference between individual surgeons [8].…”

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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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Risk Factors for Neck Hematoma after Thyroid or Parathyroid Surgery: Ten-Year Analysis of the Nationwide Inpatient Sample Database

Abstract: We identified demographic and clinical factors associated with increased risk of neck hematoma after thyroid or parathyroid surgery.

Cited by 48 publications

References 39 publications

Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures

Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures

23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients

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

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