Perioperative risk factors for post‐thyroidectomy hematoma: Significance of pain and ketorolac usage

Abstract

Background Post‐thyroidectomy hematoma (PH) is uncommon but may be a life‐threatening complication. We explored perioperative risk factors for PH, with emphasis on perioperative hemodynamics, pain, and medications. Methods A retrospective case‐control study was performed with matching for age, sex, and type of operation. Univariate and multivariate analyses were performed to identify independent risk factors. Results In 1780 thyroid surgeries, 22 cases of PH were detected (1.24%). Antithrombotic agent usage, numeric rating scale (NRS) of postoperative pain, and two or more doses of ketorolac postoperatively significantly differed between the two groups. Multiple regression analysis revealed all three variables were significant risk factors for PH (odds ratio = 55.23, 10.48, and 22.58, respectively). Perioperative hemodynamics did not affect PH. Conclusions Antithrombotic agent usage, postoperative pain, and two or more doses of ketorolac postoperatively were identified as independent risk factors for PH. Proper pain control and judicious usage of ketorolac are recommended.

Incidence and Risk Factors of Postoperative Bleeding in Patients Undergoing Total Thyroidectomy

“…Arterial bleeding was more common than venous bleeding, and the most common bleeding site was the superior thyroid artery; this finding is consistent with previous reports ( 2 , 5 , 17 ). The management of thyroid superior vessels is an important procedure, especially in patients with Hashimoto thyroiditis or thickened blood vessels.…”

“…Predictors of postoperative bleeding have been frequently evaluated ( 2 – 12 , 17 – 20 ); common risk factors include smoking, hypertension, diabetes, high BMI, operation time, disease stage, and neck dissection, and similar findings were also observed in our results. Smoking and systemic diseases can increase vascular brittleness and decrease coagulation, and postoperative cough induced by thyroid surgery can increase blood pressure ( 21 ).…”

“…Postoperative bleeding is relatively uncommon in head and neck surgery, with an incidence of approximately 1% ( 17 , 18 ); however, it is one of the most serious postoperative complications. Consistent with previous research ( 2 – 12 ), our study confirmed the value of hypertension, diabetes, BMI, operation time, disease pathology, and resection extent in predicting postoperative bleeding.…”

“…Postoperative bleeding is relatively uncommon in head and neck surgery, with an incidence of approximately 1% (17,18); however, it is one of the most serious postoperative complications.…”

A small dose of dexmedetomidine decreased the postoperative bleeding by reducing cough and emergence agitation after thyroidectomy – A randomized, double-blind, controlled study

“…According to the study of Yoo et al [21], the intensity of postoperative pain after thyroidectomy was greatest at 30 minutes after surgery in the PACU and decreased by one-third after 24 hours. As postoperative pain is identi ed as an independent risk factor for pot-thyroidectomy hemorrhage [22], the analgesic effect of dexmedetomidine may also contribute to the reduction of postoperative bleeding. However, we only measured the intensity of postoperative pain on the rst day in the PACU and this is considered a limitation point of our study.…”