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Evaluating risk factors for re-exploration due to postoperative neck hematoma after thyroid surgery : a nested case-control study

Salem, Farhad Allahyar LU ; Bergenfelz, A. LU ; Nordenström, E. LU ; Dahlberg, J. ; Hessman, O. ; Lundgren, C. I. and Almquist, M. LU (2019) In Langenbeck's Archives of Surgery 404(7). p.815-823
Abstract

Purpose: Postoperative bleeding after thyroid surgery remains a potentially lethal complication. Outpatient thyroidectomy is an increasing trend in the high volume centers. There is a need to identify risk factors for postoperative bleeding in order to select proper patients for outpatient thyroidectomy. This study aimed to investigate this issue using a national population-based register. Material and method: A nested case-control study on patients registered in the Swedish national register for endocrine surgery (SQRTPA) was performed. Patients with postoperative bleeding were matched 1:1 by age and gender to controls. Additional information on cases and controls was obtained from attending surgeons using a questionnaire. Risk factors... (More)

Purpose: Postoperative bleeding after thyroid surgery remains a potentially lethal complication. Outpatient thyroidectomy is an increasing trend in the high volume centers. There is a need to identify risk factors for postoperative bleeding in order to select proper patients for outpatient thyroidectomy. This study aimed to investigate this issue using a national population-based register. Material and method: A nested case-control study on patients registered in the Swedish national register for endocrine surgery (SQRTPA) was performed. Patients with postoperative bleeding were matched 1:1 by age and gender to controls. Additional information on cases and controls was obtained from attending surgeons using a questionnaire. Risk factors for postoperative bleeding were evaluated with logistic regression and are presented as odds ratios (ORs) with 95% confidence intervals (CIs). The time of bleeding in relation to surgery was also investigated. Results: There were 9494 operations, and 174 (1.8%) of them involved postoperative bleeding. In the whole cohort, patients with postoperative bleeding were older, 58 (46–69) vs. 49 (37–62) years, than patients without, p < 0.01. Male patients had a higher risk of bleeding, OR 2.18 (95% CI 1.58–2.99). In the case-control cohort, drain was an independent risk factor for bleeding, OR 1.64 (1.05–2.57). Two-thirds of patients bled within 6 h after surgery. The incidence of bleeding after 24 h was 10%. Conclusion: High age, male gender, and drain are independent risk factors for bleeding after thyroid surgery. Even with careful patient selection, prolonged observation might be necessary in thyroid surgery.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Postoperative bleeding, Postoperative neck hematoma, risk factors, Thyroid surgery
in
Langenbeck's Archives of Surgery
volume
404
issue
7
pages
815 - 823
publisher
Springer
external identifiers
  • pmid:31741031
  • scopus:85075369399
ISSN
1435-2443
DOI
10.1007/s00423-019-01836-4
language
English
LU publication?
yes
id
64ecb72c-0a51-47f2-91b0-2aa96dbfb5e9
date added to LUP
2019-12-10 12:13:45
date last changed
2020-03-12 03:00:33
@article{64ecb72c-0a51-47f2-91b0-2aa96dbfb5e9,
  abstract     = {<p>Purpose: Postoperative bleeding after thyroid surgery remains a potentially lethal complication. Outpatient thyroidectomy is an increasing trend in the high volume centers. There is a need to identify risk factors for postoperative bleeding in order to select proper patients for outpatient thyroidectomy. This study aimed to investigate this issue using a national population-based register. Material and method: A nested case-control study on patients registered in the Swedish national register for endocrine surgery (SQRTPA) was performed. Patients with postoperative bleeding were matched 1:1 by age and gender to controls. Additional information on cases and controls was obtained from attending surgeons using a questionnaire. Risk factors for postoperative bleeding were evaluated with logistic regression and are presented as odds ratios (ORs) with 95% confidence intervals (CIs). The time of bleeding in relation to surgery was also investigated. Results: There were 9494 operations, and 174 (1.8%) of them involved postoperative bleeding. In the whole cohort, patients with postoperative bleeding were older, 58 (46–69) vs. 49 (37–62) years, than patients without, p &lt; 0.01. Male patients had a higher risk of bleeding, OR 2.18 (95% CI 1.58–2.99). In the case-control cohort, drain was an independent risk factor for bleeding, OR 1.64 (1.05–2.57). Two-thirds of patients bled within 6 h after surgery. The incidence of bleeding after 24 h was 10%. Conclusion: High age, male gender, and drain are independent risk factors for bleeding after thyroid surgery. Even with careful patient selection, prolonged observation might be necessary in thyroid surgery.</p>},
  author       = {Salem, Farhad Allahyar and Bergenfelz, A. and Nordenström, E. and Dahlberg, J. and Hessman, O. and Lundgren, C. I. and Almquist, M.},
  issn         = {1435-2443},
  language     = {eng},
  month        = {11},
  number       = {7},
  pages        = {815--823},
  publisher    = {Springer},
  series       = {Langenbeck's Archives of Surgery},
  title        = {Evaluating risk factors for re-exploration due to postoperative neck hematoma after thyroid surgery : a nested case-control study},
  url          = {http://dx.doi.org/10.1007/s00423-019-01836-4},
  doi          = {10.1007/s00423-019-01836-4},
  volume       = {404},
  year         = {2019},
}