Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

Liu, Jinhao; Sun, Wei; Dong, Wenwu; Wang, Zhihong; Zhang, Ping; Zhang, Ting; Zhang, Hao

doi:10.1530/eje-16-0757

Cited by 95 publications

(101 citation statements)

References 52 publications

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“…2 More female patients underwent thyroid surgery; however, the incidence of PH was higher in male patients. 2 More female patients underwent thyroid surgery; however, the incidence of PH was higher in male patients.…”

Section: Discussionmentioning

confidence: 98%

“…2 In the present study, we matched these variables between control and case groups to identify other perioperative risk factors for PH that may have been overlooked, with a focus on perioperative hemodynamics and pain. 2 In the present study, we matched these variables between control and case groups to identify other perioperative risk factors for PH that may have been overlooked, with a focus on perioperative hemodynamics and pain.…”

Section: Discussionmentioning

confidence: 99%

“…Complications after thyroidectomy are wellknown, but are rare; these include recurrent laryngeal nerve paralysis, hypoparathyroidism, and post-thyroidectomy hematoma. [1][2][3][4][5][6][7][8][9][10][11] In this study, we sought to identify perioperative risk factors for PH, with emphasis on perioperative hemodynamics and medications, along with well-known risk factors, such as sex, age, and type of operation. 2 Notably, PH is an uncommon, but life-threatening complication, which can induce upper airway obstruction, acute respiratory failure, and death.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Post-thyroidectomy bleedings have been well documented [1][2][3][4]. Many factors including Grave's disease, previous thyroidectomy, and thrombocytopenia are associated with neck hematoma after thyroidectomy [4].…”

Section: Resultsmentioning

confidence: 99%

“…Some risk factors including grave's disease, bilateral operation, and previous thyroid surgery etc. were identified in a systemic review [1]. Delayed oozing is potentially life-threatening.…”

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confidence: 99%

Asphyxia Following Complete Thyrodiectomy in a Patient with Relapsed Grave’s Disease

Wu¹,

Wu²

2017

Thyroid Disorders Ther

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A rare complication of post-thyroidectomy asphyxia developed in a patient with relapsed Grave's disease. Causes of the asphyxia were preoperative tracheal narrowing, previous thyroidectomy related diffuse oozing, and long-term use of Methimazole resulting in thrombocytopenia. The patient was successfully resuscitated by removal of neck stitches and endotracheal intubation.The incidence of bleeding after thyroid surgery is low (1.48%). Some risk factors including grave's disease, bilateral operation, and previous thyroid surgery etc. were identified in a systemic review [1]. Delayed oozing is potentially life-threatening. We describe a rare complication of asphyxia following complete thyroidectomy in a patient with relapsed Grave's disease.

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Neck Circumference Measurement for Surveillance and Early Detection of Hemorrhage After Thyroidectomy

Ahnen

Schardey

Ahnen

et al. 2022

JAMA Otolaryngol Head Neck Surg

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is a potentially life-threatening complication with no reliable noninvasive method of early detection.OBJECTIVE To evaluate the diagnostic accuracy of neck circumference measurement for early detection of postoperative hemorrhage after thyroidectomy. DESIGN, SETTING, AND PARTICIPANTSThis diagnostic accuracy study at an academic teaching hospital used a prospective cohort of patients undergoing thyroid surgery from November 1, 2015, to January 31, 2018 (group 1), and a retrospective cohort of patients undergoing the same surgery from January 1, 2020, to September 30, 2021 (group 2). We performed repeated perioperative neck circumference measurements to evaluate the association of increased neck circumference with postthyroidectomy hemorrhage among patients at risk for hemorrhage. MAIN OUTCOMES AND MEASURESThe primary end point was the diagnostic value of neck circumference measurement for detection of postthyroidectomy hemorrhage. Additionally, data on demographic information and risk factors for postthyroidectomy hemorrhage were examined. Data analyses were performed from November 1, 2021, to January 5, 2022. RESULTSThe prospective cohort (group 1) comprised 60 patients (45 [75%] women) with a mean (SD) age of 52.2 (13.5) years; those who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 57.4 (9.0) years. The retrospective cohort (group 2) comprised 353 patients (258 [73%] women) with a mean (SD) age of 55.3 (14.1) years; patients who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 62.2 (10.0) years. In group 1, postoperative neck circumference increased by a median (range) of 5.0 (4.0 to 7.0) cm in patients with hemorrhage, and only 1.0 (−2.5 to 4.0) cm in patients with no postoperative bleeding (difference in the medians, 4.0 cm [95% CI, 3.0 to 5.5 cm]; effect size, 3.74 [95% CI, 2.6 to 4.9]). Defining a 7% or greater increase in neck circumference as the cutoff value for detecting postthyroidectomy hemorrhage showed a diagnostic sensitivity and specificity of 1.0 (95% CI, 0.48 to 1.0) and 0.86 (95% CI, 0.71 to 0.92), respectively. The retrospective validation also showed a difference in median (range) increase of postoperative neck circumference between patients with hemorrhage and those without-3.0 (0 to 6.0) cm vs 0.0 (−6.0 to 5.0) cm (difference in medians, 3.8 cm [95% CI, 3.0 to 4.9]; effect size, 1.63 [95% CI, 0.96 to 2.3]). Considering 12 false-positive and 332 correct-negative results, the diagnostic tool showed a sensitivity of 0.89 (95% CI, 0.51 to 0.99) and a specificity of 0.97 (95% CI, 0.94 to 0.98). CONCLUSIONS AND RELEVANCEThe findings of this diagnostic accuracy study suggest that neck circumference measurement is a feasible and easy-to-use diagnostic tool for routine clinical care to detect postthyroidectomy hemorrhage. A 7% or greater increase over the postoperative baseline neck circumference seems to be a reliable threshold for detecting postthyroidectomy hemorrhage. Neck circumference measurement should be used in combination with surveillance of clinical s...

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Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

Cited by 95 publications

References 52 publications

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

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

Asphyxia Following Complete Thyrodiectomy in a Patient with Relapsed Grave’s Disease

Neck Circumference Measurement for Surveillance and Early Detection of Hemorrhage After Thyroidectomy

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