Reexploration for symptomatic hematomas after cervical exploration

Burkey, Shelby H.; Heerden, Jon A. van; Thompson, Geoffrey B.; Grant, Clive S.; Schleck, Cathy D.; Farley, David R.

doi:10.1067/msy.2001.118384

Cited by 221 publications

(227 citation statements)

References 17 publications

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“…Undoubtedly, early discharge of patients following thyroidectomy is problematic since potentially life-threatening neck hematoma has been documented to occur beyond a short-stay, 6-hour, observation period (16)(17)(18)(19). Some authors have suggested that early discharge of patients may result in increased mortality due to this serious complication occurring outside a hospital setting (16,18).…”

Section: Discussionmentioning

confidence: 99%

“…We accept a 23-hour observation period in order to assure safe discharge of patients, not only because of the need for observation of any signs of life-threatening airway compromise, but furthermore >50% of the patients in our series were ASA III and IV. With an observation period for 23-hours, an additional 38%-50% of serious complications, otherwise missed with early discharge, would be noticed (21); supporting longer hospital stays for thyroidectomy procedures (16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter?

Belitova¹,

Pandev²,

Karadimov³

2012

Balkan Med J

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Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches. Material and Methods:We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 -under LA+MAC. All variables of patient demographic characteristics, duration and type of operation, postoperative complications, difficulty in airway management and postoperative opiate consumption were recorded and analyzed.Results: There is no difference in respect to length of stay, discharge time and major/minor complications rate between two groups, but in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p<0.001). Patient satisfaction was similar but the operator preference was greater for GA. Conclusion:In experienced hands LA with MAC for Thyroidectomy is a safe and wise choice, but GA is even more so!

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter?

Belitova¹,

Pandev²,

Karadimov³

2012

Balkan Med J

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“…[1][2][3] While a variety of factors (eg postoperative hypertension, use of anticoagulants and extent of dissection) have been implicated in increasing the risk of post-thyroidectomy haemorrhage, it is generally considered a low frequency stochastic event, which is difficult to predict. [4][5][6][7] Bleeding deep to the strap muscles is associated with a higher risk of life threatening airway swelling and obstruction, and the risk of post-thyroidectomy haemorrhage is highest in the early hours following surgery. 8 For these reasons, patients traditionally remained in hospital for 72 hours or longer after thyroidectomy.…”

mentioning

confidence: 99%

Patterns, timing and consequences of post-thyroidectomy haemorrhage

Farooq

Nouraei

Kaddour

et al. 2017

annals

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INTRODUCTION Post-thyroidectomy bleeding is a low frequency but potentially life threatening event that is very difficult to predict. Given the increasing drive towards thyroidectomy with same day discharge, this study was conducted with the aim of identifying patterns, timing and consequences of post-thyroidectomy bleeding to assess the feasibility of day-case thyroidectomy. METHODS All patients who underwent a thyroidectomy between 2008 and 2015 at our institution were identified. Patterns, timing and consequences in all those who developed post-thyroidectomy bleeding were studied. RESULTS Of the 805 patients included in the study, 14 required re-exploration for bleeding; 7 (50%) of these within 8 hours of surgery, 6 (43%) between 18 and 30 hours, and 1 (7%) at 49 hours. Just under half (43%) of those with post-thyroidectomy bleeding had thyrotoxicosis. CONCLUSIONS A significant number of postoperative haemorrhages occurred beyond the immediate postoperative period. Same day discharge after thyroidectomy cannot therefore be recommended as a routine practice.

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“…Additional complications that have been reported include massive tongue swelling (4), CSF leak (5) and hematoma (6). These latter three can present as airway obstruction because of associated anatomical distortions but none were factors in the case we report here.…”

Section: Stefanutto Tb Et Al Cervical Decompression and Unexpected Smentioning

confidence: 68%