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Langenbecks Arch Surg. 2019 Nov 18. doi: 10.1007/s00423-019-01836-4. [Epub ahead of print]

Evaluating risk factors for re-exploration due to postoperative neck hematoma after thyroid surgery: a nested case-control study.

Author information

1
Department of Clinical Sciences, Lund University, Lund, Sweden. farhad.salem@med.lu.se.
2
Department of Clinical Sciences, Lund University, Lund, Sweden.
3
Department of Endocrine Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
4
Department of Endocrine Surgery, Uppsala University Hospital, Uppsala, Sweden.
5
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.

Abstract

PURPOSE:

Postoperative bleeding after thyroid surgery remains a potentially lethal complication. Outpatient thyroidectomy is an increasing trend in the high volume centers. There is a need to identify risk factors for postoperative bleeding in order to select proper patients for outpatient thyroidectomy. This study aimed to investigate this issue using a national population-based register.

MATERIAL AND METHOD:

A nested case-control study on patients registered in the Swedish national register for endocrine surgery (SQRTPA) was performed. Patients with postoperative bleeding were matched 1:1 by age and gender to controls. Additional information on cases and controls was obtained from attending surgeons using a questionnaire. Risk factors for postoperative bleeding were evaluated with logistic regression and are presented as odds ratios (ORs) with 95% confidence intervals (CIs). The time of bleeding in relation to surgery was also investigated.

RESULTS:

There were 9494 operations, and 174 (1.8%) of them involved postoperative bleeding. In the whole cohort, patients with postoperative bleeding were older, 58 (46-69) vs. 49 (37-62) years, than patients without, p < 0.01. Male patients had a higher risk of bleeding, OR 2.18 (95% CI 1.58-2.99). In the case-control cohort, drain was an independent risk factor for bleeding, OR 1.64 (1.05-2.57). Two-thirds of patients bled within 6 h after surgery. The incidence of bleeding after 24 h was 10%.

CONCLUSION:

High age, male gender, and drain are independent risk factors for bleeding after thyroid surgery. Even with careful patient selection, prolonged observation might be necessary in thyroid surgery.

KEYWORDS:

Postoperative bleeding; Postoperative neck hematoma, risk factors; Thyroid surgery

PMID:
31741031
DOI:
10.1007/s00423-019-01836-4

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