Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis

Abstract

Background In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. Methods We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Results Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60–2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28–5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60–2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43–3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51–2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12–1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11–3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09–1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23–1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99–1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83–1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69–5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. Conclusion: We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.

Risk Factors and Outcomes of Postoperative Neck Hematomas: An Analysis of 5,900 Thyroidectomies Performed at a Cancer Center

“…International Archives of Otorhinolaryngology per year) have a lower propensity of resulting in PNH, as compared with procedures performed in low-volume hospitals. 15 We emphasize some important measures in the prevention of postthyroidectomy hematomas. Gentle tissue handling is strongly advised during thyroid surgery.…”

“…15,16,19 There is no consensus on the impact of the extent of the thyroid resection on postoperative bleeding. A higher risk of developing a postthyroidectomy hematoma has been described both after total [13][14][15][16] and partial 6 resections. We failed to show any association between the extent of the resection and the wound hematoma, possibly due to the small number of patients undergoing non-total thyroidectomies (9%) in our series.…”

Post-thyroidectomy Hypocalcemia - Risk Factors and Management

“…The complications of thyroidectomy varies from hypocalcemia and unilateral recurrent laryngeal nerve lesions (less frequent) up to very rare conditions like bilateral recurrent nerve paralysis, injury of vocal folds, local hematoma, cysts, granuloma, haemorrhage, etc (8)(9)(10). Of course, iatrogenic hypothyroidism due to thyroid removal is seen in most of cases of total resection (8)(9)(10). The complications are classified by some as early (within first 3 months) and late; they may be transient or permanent (8)(9)(10).…”

“…Of course, iatrogenic hypothyroidism due to thyroid removal is seen in most of cases of total resection (8)(9)(10). The complications are classified by some as early (within first 3 months) and late; they may be transient or permanent (8)(9)(10). Except for hypothyroidism, the others are essentially considered to be related to surgeon's skills (8)(9)(10)(11).…”

“…The complications are classified by some as early (within first 3 months) and late; they may be transient or permanent (8)(9)(10). Except for hypothyroidism, the others are essentially considered to be related to surgeon's skills (8)(9)(10)(11). Some complications are life threatening as severe hypocalcemia, bilateral vocal cords paralysis and cervical hematoma (9-12).…”