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

Abstract

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.

Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

“…Bleeding is the most common complication associated with thyroidectomy. Surgery secondary to bleeding may cause SSI, hypoparathyroidism, and recurrent nerve palsy 26 . In our study, PoH was not significantly associated with postoperative hematoma or seroma but was significantly higher in patients who developed surgical site infections.…”

Selection of parathyroidectomy methods for primary hyperparathyroidism according to concordance between ultrasonography and MIBI scan results

“…Once a surgeon touches the operation field, especially when BNE is performed, a thorough exploration is necessary. Reoperation for recurrent PHPT is associated with high failure rates and complications, especially in cases undergoing BNE (33)(34)(35). However, patients who are not cured after FP can undergo a simple second operation that can be performed in an operative field free from adhesions.…”

A Respective Observational Study of Patients on Maintenance Hemodialysis Receiving Parathyroidectomy By Ultrasonic Scalpel

“…Postoperative bleeding is usually a common complication because the thyroid is highly vascularized. In addition, serious postoperative bleeding is life-threatening because of neck hematoma [5]. Effective intraoperative hemostasis is important in neck surgery.…”

“…Bleeding is a common complication after thyroid or parathyroid operation [5,6]. The traditional operations include blood vessel ligature and electrocoagulation.…”