eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
2/2018
vol. 14
 
Share:
Share:
more
 
 
abstract:
Clinical research

Consequences of bleeding after thyroid surgery – analysis of 7805 operations performed in a single center

Beata Wojtczak, Michał Aporowicz, Krzysztof Kaliszewski, Marek Bolanowski

Arch Med Sci 2018; 14, 2: 329–335
Online publish date: 2016/10/17
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Introduction: Surgical treatment of thyroid gland diseases is associated with the possibility of severe complications. The most dangerous of them is bleeding. Current studies focus on its risk factors, rather than reoperation-related consequences.

Material and methods: We analyzed 7805 thyroid operations performed from 1996 to 2014 in the Clinic of General, Gastroenterological and Endocrine Surgery of Wroclaw Medical University. Typical risk factors, symptoms and consequences of bleeding were analyzed.

Results: Among operated patients 88.2% were female and 11.8% male. Bleeding occurred in 84 (1.08%) patients. Sex (p = 0.006), preoperative thyroid pathology (p = 0.03), and type of operation (p < 0.001) are significant risk factors for bleeding, while retrosternal goiter and surgeon’s experience are not. Risk of bleeding is highest in the case of male sex, toxic goiter and total resection of the thyroid gland. Most reoperations took place within 6 h. In 88.8% of cases of this kind of complication the surgeon indicated the exact source of bleeding; most commonly it was the neck muscles, skin and subcutaneous tissue, or the thyroid stump. Three patients required a second reoperation, 24 suffered further complications, and 8 required transfer to the Intensive Care Unit (ICU). Cardiac arrest occurred in 3 patients and 2 suffered bilateral vocal cord palsy.

Conclusions: Bleeding after thyroid operations is a direct life threat that requires immediate intervention. As a result death may occur, half of patients suffer other complications and some require intensive care. The risk is highest in the case of male sex, toxic goiter and total resection of the thyroid gland. Each patient after thyroid surgery needs to be closely observed. An operating theatre and ICU should be available at all times.
keywords:

thyroidectomy, outcomes, complications, bleeding, reoperation

references:
Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goiter. Endocr J 2005; 52: 199-205.
Zambudio AR, Rodriguez J, Riguelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004; 240: 18-25.
Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000; 24: 1335-41.
Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngoscope 2003; 113: 1820-6.
Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002; 128: 389-92.
Abbas G, Dubner S, Heller KS. Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck 2001; 23: 544-6.
Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14 934 patients operated on in Italy over 5 years. World J Surg 2004; 28: 271-6.
Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3.660 patients. Langenbecks Arch Surg 2008; 393: 667-73.
Promberger R, Ott J, Kober F, et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 2012; 99: 373-9.
Godballe C, Madsen AR, Pedersen HB, et al. Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish Departments of ENT Head and Neck Surgery. Eur Arch Othorhinolaryngol 2009; 266: 1945-52.
Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 2000; 24: 971-5.
Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 2008; 195: 339-43.
Morton R, Mak V, Moss D, Ahmad Z, Sevao J. Risk of bleeding after thyroid surgery: matched pairs analysis. J Laryngol Otol 2012; 126: 285-8.
Moumoulidis I, Martinez Del Pero M, Brennan L, Jani P. Haemostasis in head and neck surgical procedures: Valsalva manoeuvre versus Trendelenburg tilt. Ann R Coll Surg Engl 2010; 92: 292-4.
Kennedy SA, Irvine RA, Westerberg BD, Zhang H. Meta-analysis: prophylactic drainage and bleeding complications in thyroid surgery. J Otolaryngol Head Neck Surg 2008; 37: 768-73.
Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001; 130: 914-20.
Caló PG, Pisano G, Piga G, et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience. Ann Ital Chir 2010; 81: 343-7.
Hermann M, Alk G, Roka R, Glasser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27 000 nerves at risk. Ann Surg 2002; 235: 261-8.
Prim MP, De Diego J, Harisson D, et al. Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg 2001; 124: 111-4.
Basto ER, Waintrop C, Mourey FD, Landru JP, Eurin BG, Jacob LP. Intravenous ketoprofen in thyroid and parathyroid surgery. Anesth Analg 2001; 92: 1052-7.
Harding J, Sebag F, Sierra M, Palazzo FF, Henry JF. Thyroid surgery: postoperative hematoma prevention and treatment. Langenbecks Arch Surg 2006; 391: 169-73.
Sibel E, Cicero AF. Hyperthyroidism and cardiovascular complications: a narrative review on the basis of patophysiology. Arch Med Sci 2013; 9: 944-52.
Bononi M, Amore Bonapasta SA, Vari A, et al. Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 2010; 32: 1173-7.
Majid MA, Siddique MI. Major post-operative complications of thyroid surgery: preventable or not? Bangladesh Med Res Counc Bull 2008; 34: 99-103.
Joannis V, Aliki T, Nikolaos A, Fotios N, Petroipoulos T, Smyrniotis V. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: a surgical challenge. Arch Med Sci 2013; 9: 74-8.
FEATURED PRODUCTS
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe