Midwest Surgical Association
Case cohort study of risk factors for post-thyroidectomy hemorrhage

https://doi.org/10.1016/j.amjsurg.2015.10.023Get rights and content

Abstract

Background

Post-thyroidectomy hemorrhage is a potentially life-threatening complication of thyroid surgery. The goal of our study was to determine potential risk factors for development of post-thyroidectomy hemorrhage.

Methods

A retrospective case cohort study of patients with post-thyroidectomy hemorrhage between December 2008 and August 2014 was performed. This group of patients was compared with a stratified randomized control group, and several parameters were assessed for association with post-thyroidectomy hemorrhage.

Results

Sixteen patients were identified in this time period as developing post-thyroidectomy hemorrhage requiring reoperation. Postoperative hypertension, vomiting and/or straining, longer operative times, and extent of surgical dissection were found to be statistically significant risk factors. Postoperative hypertension was found to be the most significant risk factor, resulting in a 20.3 times increased likelihood of developing post-thyroidectomy hemorrhage.

Conclusions

A number of risk factors for post-thyroidectomy hemorrhage were identified. The most significant was postoperative hypertension. Early control of modifiable risk factors could improve patient outcomes and satisfaction.

Section snippets

Methods

A retrospective case cohort study of all patients with post-thyroidectomy hemorrhage between December 2008 and August 2014 was performed. During this study period, 16 patients were identified with post-thyroidectomy bleeding requiring reoperation. The hemorrhage group was compared with a stratified randomized sample of 32 patients that did not develop postoperative hemorrhage. Patients in this group were randomly selected to obtain a 2:1 ratio of nonhemorrhage to hemorrhage and were controlled

Results

For the time period of our study, 682 thyroid surgeries were performed. Overall 16 of 682 of these patients developed postoperative hemorrhage requiring reoperation, an incidence of 2.3%.

Within the hemorrhage group, median age was 54.5 (range 28 to 77). Overall 14 of 16 were female, and 2 of 16 were male. Overall 8 of 16 were Caucasian, and 8 of 16 were African American. The most common indication for surgery was goiter, and the most common operation performed was total thyroidectomy. A total

Conclusions

Several potential risk factors for post-thyroidectomy bleeding were analyzed. The parameter with the greatest association was the presence of postoperative hypertension, which was present in 81% of our hemorrhage population, and demonstrated statistically significant association with development of postoperative hemorrhage, as well as greatly increased the risk of developing postoperative hemorrhage. The most frequently encountered symptom was swelling, which was experienced by 81% of our

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    Of note, the incidence and frequency of hypertensive MAP was not analysed. Samona and colleagues recently reported postoperative systolic blood pressure >150 mmHg as the strongest risk factor for bleeding in a retrospective analysis of thyroidectomy patients (Samona et al., 2016). Morton and colleagues have described a 39% risk increase for postoperative haemorrhage for every 10 points of the highest blood pressure after thyreoid surgery (Morton and Vandal, 2015).

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There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

The authors declare no conflicts of interest.

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