Post-Thyroidectomy Hemorrhage: Time, Place, Risk, and the Surgeon

Jo Sang-Ho; Cho Jin-Seong; Na Yong Min; Ryu Young Jae; Park Min Ho; Yoon Jung Han

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자료유형: 학술저널

저자정보: Jo Sang-Ho (Department of Surgery Chonnam National University Hospital Gwangju Korea.) Cho Jin-Seong (Department of Surgery Chonnam National University Hospital Gwangju Korea.Department of Surgery Chon) Na Yong Min (Department of Surgery Chonnam National University Hwasun Hospital Hwasun Korea.) Ryu Young Jae (Department of Surgery Chonnam National University Medical School Gwangju Korea.Department of Surger) Park Min Ho (Department of Surgery Chonnam National University Medical School Gwangju Korea.Department of Surger) Yoon Jung Han (Department of Surgery Chonnam National University Medical School Gwangju Korea.Department of Surger)

저널정보: 대한갑상선-내분비외과학회 The Journal of Endocrine Surgery The Journal of Endocrine Surgery 제20권 제4호

발행연도: 2020.1

수록면: 47 - 59 (13page)

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연구배경

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연구방법

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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.

#Thyroidectomy #Hemorrhage #Hematoma #Risk factors #Surgeons

참고문헌 (24)

참고문헌 신청

Abboud B / 2009 / Thyroidectomy in patients at high-risk of bleeding : can it be safely performed / Minerva Chir 64:565~571

Calò PG / 2013 / Late bleeding after total thyroidectomy : report of two cases occurring 13 days after operation / Clin Med Insights Case Rep 6:165~170

Harding J / 2006 / Thyroid surgery : postoperative hematoma--prevention and treatment / Langenbecks Arch Surg 391:169~173

Polychronidis G / 2018 / Network metaanalysis of topical haemostatic agents in thyroid surgery / Br J Surg 105:1573~1582

Lang BH / 2012 / A review of risk factors and timing for postoperative hematoma after thyroidectomy : is outpatient thyroidectomy really safe / World J Surg 36:2497~2502

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