Post-Thyroidectomy Hemorrhage: Time, Place, Risk, and the Surgeon
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Purpose: Post-thyroidectomy hemorrhage has been conducted on re-operated reactive hemorrhage usually occurred within 24 hours. We investigated all hemorrhages including reoperated or not and also secondary hemorrhages occurred after discharge. Methods: We retrospectively reviewed 16,701 patients from 1999 to 2019 and investigated the risk factors and time patterns of post-thyroidectomy hemorrhagic events. Results: The annual incidence of hemorrhage decreased from 1.7% to 0.1%. The risk factors included age ≥55 years, male sex, body weight ≥60 kg, larger thyroid specimens, and advanced stage (stage III or IV). The type of surgery and body mass index showed no significant associations with the hemorrhagic events. Ligation methods were associated with a greater incidence of hemorrhagic events than energy devices (0.6% vs. 0.3%), but they were not independent predictive factors (odds ratio [OR]=1.5; P=0.157). The OR was high for surgeons' experience <3.5 years (OR=1.8), age ≥55 years (OR=1.8), weight ≥60 kg (OR=1.9), and aggressive tumor stage (OR=4.8). The highest OR was observed for Surgeon X's procedures (OR=9.6). Extremely severe airway obstruction was observed in 17% of the patients and one patient did not survive. Most of the hemorrhagic events occurred during hospitalization, but 13% of the events occurred at home after discharge, or in the dialysis chamber of another hospital. Conclusion: Post-thyroidectomy hemorrhagic events are life-threatening complications that can occur at unexpected times and places. Delicate hemostasis and careful monitoring even after normal discharge constitute the best approach to prevent these events. Moreover, we do not recommend routine outpatient-based thyroidectomy.
Abstract
Purpose: Post-thyroidectomy hemorrhage has been conducted on re-operated reactive hemorrhage usually occurred within 24 hours. We investigated all hemorrhages including reoperated or not and also secondary hemorrhages occurred after discharge. Methods: We retrospectively reviewed 16,701 patients from 1999 to 2019 and investigated the risk factors and time patterns of post-thyroidectomy hemorrhagic events. Results: The annual incidence of hemorrhage decreased from 1.7% to 0.1%. The risk factors included age ≥55 years, male sex, body weight ≥60 kg, larger thyroid specimens, and advanced stage (stage III or IV). The type of surgery and body mass index showed no significant associations with the hemorrhagic events. Ligation methods were associated with a greater incidence of hemorrhagic events than energy devices (0.6% vs. 0.3%), but they were not independent predictive factors (odds ratio [OR]=1.5; P=0.157). The OR was high for surgeons' experience <3.5 years (OR=1.8), age ≥55 years (OR=1.8), weight ≥60 kg (OR=1.9), and aggressive tumor stage (OR=4.8). The highest OR was observed for Surgeon X's procedures (OR=9.6). Extremely severe airway obstruction was observed in 17% of the patients and one patient did not survive. Most of the hemorrhagic events occurred during hospitalization, but 13% of the events occurred at home after discharge, or in the dialysis chamber of another hospital. Conclusion: Post-thyroidectomy hemorrhagic events are life-threatening complications that can occur at unexpected times and places. Delicate hemostasis and careful monitoring even after normal discharge constitute the best approach to prevent these events. Moreover, we do not recommend routine outpatient-based thyroidectomy.
참고문헌 (24)
- Abboud B, "Thyroidectomy in patients at high-risk of bleeding : can it be safely performed", Minerva Chir, 64, pp.565~571 (2009)
- Calò PG, "Late bleeding after total thyroidectomy : report of two cases occurring 13 days after operation", Clin Med Insights Case Rep, 6, pp.165~170 (2013)
- Harding J, "Thyroid surgery : postoperative hematoma--prevention and treatment", Langenbecks Arch Surg, 391, pp.169~173 (2006)
- Polychronidis G, "Network metaanalysis of topical haemostatic agents in thyroid surgery", Br J Surg, 105, pp.1573~1582 (2018)
- Lang BH, "A review of risk factors and timing for postoperative hematoma after thyroidectomy : is outpatient thyroidectomy really safe", World J Surg, 36, pp.2497~2502 (2012)
- Liu J, "Risk factors for post-thyroidectomy haemorrhage : a meta-analysis", Eur J Endocrinol, 176, pp.591~602 (2017)
- Wojtczak B, "Consequences of bleeding after thyroid surgery-analysis of 7805 operations performed in a single center", Arch Med Sci, 14, pp.329~335 (2018)
- Promberger R, "Risk factors for postoperative bleeding after thyroid surgery", Br J Surg, 99, pp.373~379 (2012)
- 이형신, "Patterns of Post-thyroidectomy Hemorrhage", Clinical and Experimental Otorhinolaryngology, 2(2), pp.72~77 (2009), 대한이비인후과학회
- Farooq MS, "Patterns, timing and consequences of post-thyroidectomy haemorrhage", Ann R Coll Surg Engl, 99, pp.60~62 (2017)
- Edafe O, "Reoperation for bleeding after thyroid and parathyroid surgery : incidence, risk factors, prevention, and management", World J Surg, 44, pp.1156~1162 (2020)
- Ishikawa M, "The value of acoustic respiratory rate monitoring in a patient with postoperative hemorrhage after thyroidectomy : a case report", J Clin Monit Comput, 34, pp.147~150 (2020)
- Beyoglu CA, "A comparison of the efficacy of three different peak airway pressures on intraoperative bleeding point detection in patients undergoing thyroidectomy : a randomized, controlled, clinical trial", BMC Surg, 20, pp.69~ (2020)
- Scaroni M, "Effectiveness of hemostatic agents in thyroid surgery for the prevention of postoperative bleeding", Sci Rep, 10, pp.1753~ (2020)
- Bergamaschi R, "Morbidity of thyroid surgery", Am J Surg, 176, pp.71~75 (1998)
- Bergenfelz A, "Complications to thyroid surgery : results as reported in a database from a multicenter audit comprising 3, 660 patients", Langenbecks Arch Surg, 393, pp.667~673 (2008)
- Burkey SH, "Reexploration for symptomatic hematomas after cervical exploration", Surgery, 130, pp.914~920 (2001)
- Pontin A, "Postoperative bleeding after thyroid surgery : care instructions", Sisli Etfal Hastan Tip Bul, 53, pp.329~336 (2019)
- Tonante A, "Haemorrhagic complications in thyroid surgery. Control of bleeding from retroneural vessels using collagen and thrombin gelatine granules", Chir Ital, 58, pp.61~68 (2006)
- Ahn HS, "Korea's thyroid-cancer"epidemic"--screening and overdiagnosis", N Engl J Med, 371, pp.1765~1767 (2014)
- Zhang X, "Risk factors for postoperative haemorrhage after total thyroidectomy : clinical results based on 2, 678 patients", Sci Rep, 7, pp.7075~ (2017)
- Xie QP, "The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach : experience of 1932cases", Endocrine, 63, pp.422~429 (2019)
- Elfenbein DM, "Surgical site infection after thyroidectomy : a rare but significant complication", J Surg Res, 190, pp.170~176 (2014)
- 정소영, "갑상선절제술 후 혈종의 임상 양상", Annals of Surgical Treatment and Research, 67(04), pp.286~289 (2004), 대한외과학회