Patterns, timing and consequences of post-thyroidectomy haemorrhage

Farooq, Minaam; Nouraei, S.A.R.; Kaddour, Hesham; Saharay, M.

doi:10.1308/rcsann.2016.0270

Cited by 27 publications

(40 citation statements)

References 23 publications

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“…The reoperation rate for bleeding in our unit was 1.3%. This falls within the range reported in the literature (0.07 to 4.2%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Generally, lower rates of reoperation for bleeding have been reported in patients undergoing parathyroid surgery alone (0 to 1.1%) [2,11,16,18,19] or when rates in parathyroid surgery and thyroid surgery are pooled (0.4 to 0.8%) [2,11,16,19].…”

Section: Discussionsupporting

confidence: 83%

“…The occurrence of significant bleeding 6 h after surgery is cited as a concern in the routine adoption of day case thyroid surgery [28]. Given most bleeds occur within 24 h after surgery, some have argued for at least 24 h of observation [13]. Others have argued that day case thyroid surgery is feasible with appropriate patient selection, patient support system, and experienced surgical teams [19].…”

Section: Management Of Bleeding After Thyroid And/ or Parathyroid Surmentioning

confidence: 99%

“…Bleeding after thyroid or parathyroid surgery is a lifethreatening emergency as it has the potential to compromise the airway [1]. Reoperation for bleeding can be considered an objective way of quantifying rates of significant bleeding and has been reported to occur in around 0.07 to 4.2% of such neck operations [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management

2019

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Introduction Bleeding after thyroid and/or parathyroid surgery is a life-threatening emergency. The aim of this study was to determine the rates of reoperation following bleeding, identify risk factors, assess management strategies and outcomes, and develop protocols to reduce risk and improve management of bleeding. Methods A retrospective cohort study of all consecutive patients who underwent thyroid and/or parathyroid surgery over a 7-year period was conducted. A nested case-control design was used to evaluate specific factors and their association with reoperation for bleeding. Results Of 1913 patients, 25 (1.3%) underwent reoperation for bleeding. Of the 25 patients who bled, 6 (24%) required reoperation before leaving theatre; 17 (68%) had bleeding within 6 h, 1 (4%) between 6 and 24 h, and 1 (4%) after 24 h. Reoperation for bleeding was not associated with age, gender, or surgeon. Patients who had total thyroidectomy were more likely to have reoperation for bleeding compared to hemithyroidectomy (p = 0.045) or parathyroidectomy (p = 0.001). The following factors were not associated with bleeding: neck dissection, redo surgery, drain use, blood-thinning medication or clotting disorders, and BMI. Patients who had reoperation for bleeding had longer hospital stay (p = 0.001), but similar rates of RLN palsy, wound infection, and hypoparathyroidism. Conclusion A higher risk profile for significant post-operative bleeding cannot be determined in patients undergoing thyroid surgery. Based on this experience, we developed protocols to reduce the risk of bleeding (the ITSRED Fred protocol) and for the early detection and management of bleed (the SCOOP protocol) following thyroid and/or parathyroid surgery.

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Section: Discussionsupporting

confidence: 83%

Section: Management Of Bleeding After Thyroid And/ or Parathyroid Surmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management

2019

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“…In the present study, two patients with PH had dyspnea, and oxygen saturation in blood continued to decline; after emergency tracheotomy at the bedside, and timely hemostasis in the operating room, their lives were saved. OS at 5 years for the three groups was 90.70%, slightly lower than that reported by Liu et al 13 and Farooq et al 14,15 This difference may have been due to the late stage of enrolment, older age and other systemic diseases.…”

Section: Discussioncontrasting

confidence: 61%

<p>Impact of the Body Mass Index on Hemorrhage After Surgery for Thyroid Cancer</p>

P¹,

Luo²,

Guo³

et al. 2020

CMAR

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Objective: To investigate the effects of different values of the body mass index (BMI) on postoperative hemorrhage (PH) in thyroid cancer (TC) and its clinical management. Methods: This retrospective cohort study selected 43 patients with hemorrhage after TC surgery in 7413 cases. Patients were divided based on the BMI (kg/m 2) into normal (24), overweight group (24 ≤BMl<28) and obese (≥28) groups. Clinical and pathologic data, bleeding cause, bleeding site, treatment and prognosis were assessed. Results: BMI (P=0.038) is an independent risk factor for PH of TC, related to hypertension (P=0.004) and coronary heart disease (P=0.001) in the three groups. Preoperative weight loss was not noted (P=0.477). Hemorrhage in 60.47% of patients occurred between 4 h and 8 h after surgery. The higher the BMI, the longer was the operative time (≥1 h, 65.12%) (P=0.017), which resulted in greater intraoperative blood loss (≥20 mL, 74.42%) (P=0.025), postoperative hypoparathyroidism (P=0.015) and the probability of injury to the recurrent laryngeal nerve (P=0.026). The main causes of bleeding were incomplete vascular ligation (30.23%), severe postoperative cervical activity (16.28%) and long-term use of anticoagulant drugs (11.63%). Overall survival at 5 years in the obese group was poor (P=0.015). Forty patients (93.02%) underwent surgical exploration and hemostasis and two patients (4.65%) underwent tracheotomy. All PH complications disappeared completely after active postoperative treatment, and all patients were discharged from hospital. Conclusion: Obesity is closely associated with PH in TC patients. Therefore, in obese patients, active prevention preoperatively, complete hemostasis intraoperatively, early detection and timely treatment postoperatively are the key factors to reduce PH risk.

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“…The finding of bleeding occurring within 24 hours is consistent with results from other studies, which showed that all significant hemorrhage associated with thyroid surgery usually occurs within 24 hours of surgery. [17][18][19] Twenty-four hours is the standard observation time for short stay thyroidectomy. Present study, combined with evidence from other studies, showed that the short stay model does not pose any additional safety risks to patients in terms of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

2020

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Background: The practice of short stay thyroidectomy is relatively new in developing nations like Nigeria. The primary reason for this is a lack of resources. Furthermore, the prevailing poverty prevents many patients from accessing tertiary health care, as such, ad hoc medical outreaches are usually conducted to bridge the gap. Thyroidectomies have not been routinely performed in these outreach settings due to safety concerns. The study seeks to analyse whether short stay thyroidectomy can be safely practiced under medical outreach settings with limited resources.Methods: The study is a prospective review of all patients that had short stay thyroidectomy at four rural medical outreach settings in Nigeria. Entire study spanned January 2019 to November 2019. Each outreach lasted one week, and patients were followed up for the duration of the outreach. All patients presenting at the outreach locations and diagnosed with goiters who have had no prior neck surgeries, are euthyroid, have no locally advanced malignancies or intrathoracic goiters, have adequate social support, possess a telephone, and have accommodation within the local government area where the outreach is carried out were included in the study. Exclusion criteria included patients who did not satisfy any of the above listed inclusion criteria. Thyroidectomy was done through a standard cervicotomy. Descriptive statistics were applied.Results: A total of 81 patients with non-toxic goiters had thyroid surgery. There were 76 (94%) females and five (6%) males. Average age was 46 years. Sixty-nine (85.2%) patients had no complication, while 12 (14.8%) patients had complications. Seventy-seven (95.1%) patients were discharged within 24 hours of surgery, while four (9.4%) patients were discharged within 48 hours. There was no mortality.Conclusions: The short-stay thyroidectomy model is feasible and safe in our environment, even in the presence of limited resources, and provides an alternative to the traditional 72 hour postoperative hospital stay.

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Patterns, timing and consequences of post-thyroidectomy haemorrhage

Cited by 27 publications

References 23 publications

Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management

Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management

<p>Impact of the Body Mass Index on Hemorrhage After Surgery for Thyroid Cancer</p>

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

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