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Zheng X, Wang F, Su YC, Xu CY, Wang MZ. Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis. BMC Surg 2024; 24:122. [PMID: 38658932 PMCID: PMC11041004 DOI: 10.1186/s12893-024-02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
Various studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of "seroma formation that required invasive treatment" indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.
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Affiliation(s)
- XiaoGang Zheng
- Jinhua Maternity and Child Health Care Hospital, Surgery, Xia man University, Jinhua City, 324100, China
| | - Fan Wang
- Jinhua Central Hospital, Surgery, Zhejiang University, Jinhua City, 324100, China
| | - Yong Cheng Su
- Xiamen Key Laboratory for Tumor Metastasis, Cancer Research Center, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Chao Yang Xu
- Jinhua Central Hospital, Surgery, Zhejiang University, Jinhua City, 324100, China.
| | - Ming Zheng Wang
- Jinhua Central Hospital, Surgery, Shandong University, Jinhua City, 324100, China
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2
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Guidi G, Santos C, Pinto-de-Sousa J. Routine Use of Neck Drains Following Thyroid Operations to Prevent Complications Is No Longer Advisable. Cureus 2024; 16:e54388. [PMID: 38505452 PMCID: PMC10949187 DOI: 10.7759/cureus.54388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The use of cervical drains to prevent cervical hematoma or seroma after thyroidectomy remains a controversial issue. OBJECTIVE Identify clinical and surgical risk factors for hematoma or seroma and evaluate the usefulness of routine use of drains following thyroid surgery. MATERIAL AND METHODS The authors conducted a retrospective multicentric study related to consecutive patients submitted to thyroid surgery in seven Portuguese hospitals between January 2018 and December 2020 (n=945). The data collected included the following parameters: age and gender of the patients, anticoagulation or anti-aggregating therapy, histological diagnoses, type of surgery, the presence or absence of postoperative drains, thyroid weight, length of hospital stay, postoperative complications, and reinterventions. In this study, surgical complications evaluated were limited to the presence of hematoma or seroma. A total of 945 patients who underwent thyroid surgery were included in the study. Twenty-seven patients (2.9%, n=27) experienced complications classified as hematomas or seromas. In the series, significant differences were observed between the two groups according to hypocoagulation or anti-aggregation status (OR=3.62; 95% CI 1.14-11.4) (p=0.001) and the nature of histological diagnosis (toxic vs. non-toxic benign disease) (OR=6.59; 95% CI 1.83-23.7). Hypocoagulation or anti-aggregation status were independently associated with a higher risk of complications. The presence of drains was associated with longer hospitalization periods (p<0.001) and not a decreased need for reintervention. CONCLUSION Cervical hematoma or seroma are rare complications associated with both hypocoagulation and anti-aggregation therapy and with the presence of benign toxic pathology. The use of drains does not decrease the need for reintervention and is even associated with a longer length of hospital stay; therefore, their routine use should not be advised.
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Affiliation(s)
- Gonçalo Guidi
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - Carlos Santos
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
| | - João Pinto-de-Sousa
- Surgery, Clinical Academic Centre Trás-Os-Montes e Alto Douro, Vila Real, PRT
- General Surgery, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, PRT
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3
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Ortoleva J, Drake FT, Moor A, Ortega R. Hematoma with Airway Compromise after Thyroidectomy. Anesthesiology 2024; 140:142-143. [PMID: 37931008 DOI: 10.1097/aln.0000000000004718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Jamel Ortoleva
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - F Thurston Drake
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Amy Moor
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Rafael Ortega
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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Li Y, Li S, Jiang L, Liu Y, Miao C, Liang C. Effect-site concentrations of remifentanil for smooth emergence from combined epidural-general anesthesia or general anesthesia in patients using video double-lumen tube: A randomized trial. Heliyon 2023; 9:e18897. [PMID: 37593612 PMCID: PMC10428031 DOI: 10.1016/j.heliyon.2023.e18897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Objective The present study aimed to determine the effect-site concentration of remifentanil of 90% (EC90) for smooth emergence in patients with a video DLT (VDLT) under sevoflurane-maintained general anesthesia and to investigate whether the EC90 was affected by epidural anesthesia. Methods One hundred and twenty patients who underwent video-assisted thoracic surgery (VATS) were enrolled. Patients received either general anesthesia combined with epidural anesthesia (PEA group, n = 60) or general anesthesia (GA group, n = 60). The primary outcome was the EC90 for smooth emergence in both groups. The secondary outcomes were intraoperative emergence, smooth emergence, recovery, and hemodynamic profiles in both groups. Result The EC90 values for smooth emergence in patients using VDLT were 3.5 ng/ml (95% confidence interval [CI], 3.3-4.4 ng/ml) in the PEA group and 2.7 ng/ml (95% CI, 2.5-3.2 ng/ml) in the GA group. The total amount of remifentanil infusion during emergency was significantly higher in the PEA group (164.6 ± 47.9 μg) than in the GA group (127.1 ± 30.4 μg) (P < 0.001). The number of patients who experienced hypotension during emergency in the PEA group was higher than that in the GA group (46.7% versus 13.3%, P < 0.001). Conclusion The EC90 of remifentanil for smooth emergence in patients with VDLT under general anesthesia combined with epidural anesthesia (3.5 ng/ml) was higher than that under general anesthesia (2.7 ng/ml). Trial registration Chinese Clinical Trial Registry, ChiCTR2100054230.
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Affiliation(s)
- Yuxin Li
- Department of Anesthesiology, Zhongshan Hospital. Fudan University, Shanghai, People's Republic of China
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China
| | - Siying Li
- Department of Anesthesiology, Zhongshan Hospital. Fudan University, Shanghai, People's Republic of China
| | - Ling Jiang
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China
| | - Yiming Liu
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital. Fudan University, Shanghai, People's Republic of China
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China
| | - Chao Liang
- Department of Anesthesiology, Zhongshan Hospital. Fudan University, Shanghai, People's Republic of China
- Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China
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5
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Galluzzi F, Garavello W. Complications of revision surgery in case of bleeding after thyroid surgery: A systematic review. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:171-176. [PMID: 36792445 DOI: 10.1016/j.anorl.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES The aim of this review is to evaluate complications in patients undergoing surgical control of bleeding after thyroid surgery. Secondly, we have analyzed the rate of the main complications. METHODS The databases PubMed and EMBASE were searched for articles regarding complications after revision thyroid surgery for bleeding. A Systematic review methodology based on Preferred Reporting Items for Systematic Reviews and Meta-analysis was performed. RESULTS Nine studies met the inclusion criteria, six are retrospectives and three retrospectives controlled. The overall rate of bleeding after thyroid surgery was 1.38%. In these patients, the most common complication after revision surgery for bleeding is hypoparathyroidism 24.9% (95% CI: 20.7-29.5) followed by recurrent laryngeal nerve injury 8.1% (95% CI: 6.4-10.1) and wound infection 4.5% (95% CI: 2.5-7.6). Tracheostomy and other lethal complications are rarely described. CONCLUSION Although rare, complications after surgical control of bleeding in patients undergoing thyroid surgery can be serious. Therefore, in order to optimize the surgical outcomes, standardized protocol providing early detection and precise hemostasis procedure, is needed. Specific patient-informed consent for this condition should be created.
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Affiliation(s)
- F Galluzzi
- Department of Otorhinolaryngology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - W Garavello
- Department of Otorhinolaryngology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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6
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Guerin C, Van Den Heede K, Deguelte S, Najah H, Donatini G. Prevention and management of post-thyroidectomy cervical haematoma. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d'endocrinologie) and the SFMN (Société française de médecine nucléaire). J Visc Surg 2023:S1878-7886(23)00081-4. [PMID: 37208220 DOI: 10.1016/j.jviscsurg.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Post-thyroidectomy cervical haematoma (PTCH) requiring reoperation occurs in fewer than 5% of patients but can be fatal or leave severe neurological sequelae if compressive. Risk factors besides anticoagulant treatments are discussed. Preoperative prevention complies with the recommendations of the French Society of Anaesthesia and Resuscitation (SFAR) for the management of antiaggregants and anticoagulants before and after the operation. Intraoperative prevention is centred on careful haemostasis, sometimes aided by coagulation tools and haemostatic agents, although there is no firm evidence of their effectiveness against the occurrence of PTCH. Systematic drainage of the thyroid cavity is no longer standard practice for the prevention of PTCH. Postoperatively, maintenance of normal blood pressure is essential to prevent PTCH, together with control of pain, coughing, nausea and vomiting. To reduce the risk of serious complications, medical and paramedical teams must be trained to recognise a haematoma and manage it so that it can be evacuated as a matter of extreme urgency, if necessary bedside, and then treated for its cause in the operating theatre.
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Affiliation(s)
- Carole Guerin
- Department of General, Endocrine and Metabolic Surgery, CHU La Conception, AP-HM, Aix-Marseille University, 147, boulevard Baille, 13005 Marseille, France.
| | - Klaas Van Den Heede
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Sophie Deguelte
- Department of endocrine, digestive and oncological surgery, Robert-Debré university hospital, Reims, France
| | - Haythem Najah
- Department of digestive and endocrine surgery, Haut Leveque Hospital, university hospital of Bordeaux, Bordeaux University, Bordeaux, France
| | - Gianluca Donatini
- Department of Visceral and Endocrine Surgery, CHU of Poitiers, University of Poitiers, Poitiers, France
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7
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Su D, Zhang Z, Xia F, Li X. The safety, benefits and future development of overnight and outpatient thyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1110038. [PMID: 37091845 PMCID: PMC10113618 DOI: 10.3389/fendo.2023.1110038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
With the development of medical care, the safety of thyroidectomy is improving year by year. Due to economic benefits and other advantages of the overnight and outpatient thyroidectomy, more and more patients and medical institutions have favored overnight and outpatient thyroidectomy, and its proportion in thyroidectomy has increased year by year. However, overnight and outpatient thyroidectomy still faces many challenges and remains to be improved. In this review, we focused on the recent progress and the relevant clinical features of overnight and outpatient thyroidectomy, including its safety, economic benefits, etc., which may bring valuable clues and information for further improvements of patient benefits and promotions of overnight or outpatient thyroidectomy in the future.
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Affiliation(s)
- Duntao Su
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeyu Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fada Xia
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
| | - Xinying Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
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8
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Das D, Gayen GC, Pradhan A, Maitra M. Complications of Thyroidectomy and Learning Curve for Thyroid Surgeons: An Institutional Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:94-99. [PMID: 37007885 PMCID: PMC10050524 DOI: 10.1007/s12070-023-03480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/30/2023] Open
Abstract
To study the complications of thyroidectomy and the various methods to be followed in the intra and post-operative period to prevent complications. It is a prospective study of 5 years and 9 months duration from 1/1/2015 to 31/9/2020 done in a tertiary care hospital. A total of 268 patients were included in this study. Adequate measures were taken intraoperatively to prevent any complications and the patients were observed post-operatively for development and management of any complications. The patients were followed up regularly. Out of the 268 thyroidectomies performed in our study following which 5 patients had hemorrhage, 19 patients had temporary recurrent laryngeal nerve dysfunction, 3 patients developed respiratory obstruction, 12 patients developed transient parathyroid insufficiency, 62 patients developed thyroid insufficiency,1 patient had permanent parathyroid insufficiency, permanent recurrent laryngeal nerve dysfunction was seen in 7 patients, 3 patients developed seroma formation, 7 patients developed post-operative hypertrophic scar and 3 developed keloid. Sound anatomical knowledge, meticulous surgical technique and effective protocol for the management of complication can reduce the postoperative morbidity of the patient.
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Affiliation(s)
- Debabrata Das
- Department of ENT and Head Neck Surgery, R G Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, West Bengal 700004 India
| | - Ganesh Chandra Gayen
- Department of ENT and Head Neck Surgery, Malda Medical College & Hospital, Singatala, Uma Roy Sarani, Malda Town, West Bengal 732101 India
| | - Anurag Pradhan
- Department of ENT and Head Neck Surgery, Jalpaiguri Medical College and Hospital, Hospital Road, Jalpaiguri, 735101 India
| | - Mainak Maitra
- Department of ENT and Head Neck Surgery, IPGMER & SSKM Hospital, 244, AJC Bose Road, Kolkata, West Bengal 700020 India
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9
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Fan X, Cai H, Pan B, Xie Y. Comparison of dexmedetomidine and remifentanil on reducing coughing during emergence from anesthesia with tracheal intubation: A meta-analysis. Front Pharmacol 2022; 13:993239. [PMID: 36249748 PMCID: PMC9561905 DOI: 10.3389/fphar.2022.993239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Dexmedetomidine and remifentanil are well known to suppress airway reflex during emergence from anesthesia, but which one is more effective is unclear. We conducted a meta-analysis to compare the effect of dexmedetomidine and remifentanil on reducing the occurrence of coughing.Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (published between 1 January 1950, and 30 December 2021; no language restrictions) comparing dexmedetomidine infusion with remifentanil infusion. The primary endpoint was the incidence of moderate to severe coughing during the recovery period. The secondary endpoints were the time of recovery and extubation, and residual sedation. We assessed pooled data by using a random-effects model.Results: Eight studies with 502 participants were included. The meta-analysis showed no statistically difference between dexmedetomidine and remifentanil in the occurrence of moderate to severe coughing during emergence from anesthesia (OR 1.45,95%CI 0.62–3.38), the extubation time (MD 0.93 min, 95%CI -0.28–2.14), and the residual sedation (OR 2.52, 95%CI 0.92–6.91). Compared with dexmedetomidine, the average recovery time of remifentanil was shorter (MD 3.88 min, 95%CI 1.01–6.75).Conclusion: Dexmedetomidine and remifentanil infusion had no difference in the occurrence of moderate to severe coughing during emergence from anesthesia.Clinical Trial Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021239710
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Affiliation(s)
- Xing Fan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hai Cai
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bingbing Pan
- Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Yubo Xie,
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10
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Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy. J Clin Med 2022; 11:jcm11195791. [PMID: 36233658 PMCID: PMC9571820 DOI: 10.3390/jcm11195791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Bleeding after total thyroidectomy remains a rare event that affects early postoperative morbidity, occurring in 0.3% to 4.2% of cases. Intraoperative bleeding is an unpleasant complication, and it is often easily manageable, although postoperative bleeding may represent a life-threatening condition for the patient. The purpose of our study was to clarify the role of the Valsalva manoeuvre to reduce postoperative bleeding. Between January 2019 to February 2022, 250 consecutive patients were listed for thyroid surgery at our surgical department. The study cohort consisted of 178 patients, divided into two groups based on the execution of the Valsalva manoeuvre. There was no difference in the duration of surgery between groups. Group B had fewer reinterventions for bleeding. Group A had a significantly greater volume of drainage output than Group B. Cervical haematoma can compromise a patient’s life, so bleeding control is crucial. Our results show that using a simple and safe Valsalva manoeuvre can improve the postoperative course with a significant reduction in drainage output, but does not prevent the risk of reoperation for hemorrhage.
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11
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Tausanovic K, Zivaljevic V, Grujicic SS, Jovanovic K, Jovanovic V, Paunovic I. Case Control Study of Risk Factors for Occurrence of Postoperative Hematoma After Thyroid Surgery: Ten Year Analysis of 6938 Operations in a Tertiary Center in Serbia. World J Surg 2022; 46:2416-2422. [PMID: 35798991 DOI: 10.1007/s00268-022-06634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-thyroidectomy bleeding is rare, but potentially life-threatening complication. Early recognition with immediate intervention is crucial for the management of this complication. Therefore, it is very important to identify possible risk factors of postoperative hemorrhage as well as timing of postoperative hematoma occurrence. METHODS Retrospective review of 6938 patients undergoing thyroidectomy in a tertiary center in a ten year period (2009-2019) revealed 72 patients with postoperative hemorrhage requiring reoperation. Each patient who developed postoperative hematoma was matched with four control patients that did not develop postoperative hematoma after thyroidectomy. The patients and controls were matched by the date of operation and surgeon performing thyroidectomy. RESULTS The incidence of postoperative bleeding was 1.04%. On univariate analysis older age, male sex, higher BMI, higher ASA score, preoperative use of anticoagulant therapy, thyroidectomy for retrosternal goiter, larger thyroid specimens, larger dominant nodules, longer operative time, higher postoperative blood pressure and the use of postoperative subcutaneous heparin were identified as risk factors for postoperative bleeding. Sixty-nine patients (95.8%) bled within first 24 h after surgery. CONCLUSION The rate of postoperative bleeding in our study is consistent with recent literature. Male sex, the use of preoperative anticoagulant therapy, thyroidectomy for retrosternal goiter and the use of postoperative subcutaneous heparin remained statistically significant on multivariate analysis (p < 0.001). When identified, these risk factors may be an obstacle to the outpatient thyroidectomy in our settings.
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Affiliation(s)
- Katarina Tausanovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia. .,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia.
| | - Vladan Zivaljevic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Sandra Sipetic Grujicic
- Faculty of Medicine, Institute of Epidemiology, Belgrade University, Visegradska 26, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Ksenija Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Vesna Jovanovic
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
| | - Ivan Paunovic
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Koste Todorovica 8, 11000, Belgrade, Serbia.,Faculty of Medicine, Belgrade University, Doktora Subotica 8, 11000, Belgrade, Serbia
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12
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Wirth U, Schardey J, Bonleitner M, Weber D, von Ahnen T, Ladurner R, Andrassy J, Werner J, Schardey HM, Schopf S. A cervical compartment syndrome impairs cerebral circulation in post-thyroidectomy hemorrhage: data from an animal model. Gland Surg 2022; 11:651-662. [PMID: 35531110 PMCID: PMC9068534 DOI: 10.21037/gs-21-910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/25/2022] [Indexed: 06/26/2024]
Abstract
BACKGROUND Post thyroidectomy hemorrhage is a potentially life-threatening complication. As the mechanism leading to hypoxemic brain damage and death is still unknown, our aim was to examine the underlaying pathophysiology in an animal model. METHODS A series of experiments was performed in our established model for post thyroidectomy hemorrhage in 6 pigs. First, post thyroidectomy hemorrhage was simulated with an artificial increase of cervical compartment pressure. Second, spontaneous bleeding into the cervical compartment was initiated. Primary outcome measure is the correlation between cerebral oxygenation and cervical compartment pressure. RESULTS With an increase in cervical compartment pressure apnea could be detected in all experiments. A significant 24.2% (9.5-34.4%) decrease of cerebral oxygenation at time of apnea (47.0%; 38.0-65.0%) compared to baseline values (63.5%; 56.0-74.0%; P=0.043) occurred due increase of cervical compartment pressure concurrent with an impaired cerebral perfusion. Apnea occurred about 200 sec after a 10% decrease of cerebral oxygenation, but 35 sec before a 10% decrease of peripheral oxygenation. Spontaneous bleeding into the cervical compartment causes an increase of cervical compartment pressure reaching levels of the mean arterial blood pressure 56.0 (35.0-72.0) mmHg. CONCLUSIONS Peripheral hypoxemia occurs with relevant delay in time after decrease of cerebral perfusion and cerebral hypoxemia, therefore cerebral hypoxemia seems to be causal for a central apnea. With this evidence of impaired cerebral perfusion and cerebral hypoxemia due to an increased cervical compartment pressure we can disprove the historic theory of tracheal collapse due to a compressive hematoma in post thyroidectomy hemorrhage. A cervical compartment syndrome seems to be causal, not only for brain hypoxemia but also an additional laryngo-pharyngeal mucosal edema.
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Affiliation(s)
- Ulrich Wirth
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Josefine Schardey
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Magdalena Bonleitner
- Department for General, Visceral, Endocrine and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Desiree Weber
- Department for General, Visceral, Endocrine and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
- Center for Anesthesiology, Regional Hospital Lörrach, Lörrach, Germany
| | - Thomas von Ahnen
- Institute for Surgical Research Oberbayern, Hausham, Germany
- Department for General, Visceral, Endocrine and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Roland Ladurner
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Joachim Andrassy
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hans Martin Schardey
- Institute for Surgical Research Oberbayern, Hausham, Germany
- Department for General, Visceral, Endocrine and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Stefan Schopf
- Institute for Surgical Research Oberbayern, Hausham, Germany
- Surgical Department, RoMed Klink Bad Aibling, Bad Aibling, Germany
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13
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Phillips A, Graham J, Eyeington C, Mercer I, Taylor C, Farrell S. THYRAID: a cognitive aid for the management of neck haematoma following thyroid surgery. ANZ J Surg 2022; 92:320-324. [PMID: 35305066 DOI: 10.1111/ans.17393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Anna Phillips
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Anaesthetics, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Jon Graham
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Christopher Eyeington
- University Division of Anaesthesia, Cambridge University Hospital, Austin Health, Melbourne, Victoria, Australia
| | - Inga Mercer
- Education Department, Austin Health, Melbourne, Victoria, Australia
| | - Carmel Taylor
- Intensive Care Unit, Austin Health, Melbourne, Victoria, Australia
| | - Stephen Farrell
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, Royal Childrens Hospital, Melbourne, Victoria, Australia
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14
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Palop IF, Martínez CF, Giménez MJS, Azorin Samper MC, Fuster RG. Determination of calcium and parathyroid hormone levels following hemithyroidectomy. Thyroid Res 2021; 14:13. [PMID: 34082812 PMCID: PMC8173986 DOI: 10.1186/s13044-021-00104-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background and objective Hypocalcemia is one of the main complications of thyroid surgery. We hypothesized that hemithyroidectomy may have an impact on serum parathyroid hormone (PTH) and calcium levels despite only one thyroid lobe is manipulated. The objective of this study was to analyze changes in serum PTH and calcium levels following hemithyroidectomy. Methods This is a prospective study of 53 patients who underwent thyroid lobectomy. The serum PTH level was determined in the preoperative period, 15 min after extraction of the surgical specimen, and 24 h and 3 weeks after surgery. Serum ionized calcium was also measured in the preoperative period and at 6 h, 24 h and 3 weeks after surgery. We assessed the postoperative calcium value and its relationship with the extent of fall in PTH levels in the postoperative period. Results None of the patients had the postoperative serum ionised calcium level less than 4 mg/dl. The decrease in postoperative calcium was statistically significant at 6 and 24 h after surgery; there was no difference at 3 weeks post-surgery. The change in post-operative serum PTH levels followed a similar trend to postoperative serum calcium levels. Conclusions Although serum calcium level decreased after a lobectomy, it always remained above 4 mg/dl. We conclude that hypocalcaemia is rare following hemithyroidectomy.
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15
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Edafe O, Cochrane E, Balasubramanian SP. Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management. World J Surg 2020; 44:1156-1162. [PMID: 31822944 DOI: 10.1007/s00268-019-05322-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Bleeding after thyroid and/or parathyroid surgery is a life-threatening emergency. The aim of this study was to determine the rates of reoperation following bleeding, identify risk factors, assess management strategies and outcomes, and develop protocols to reduce risk and improve management of bleeding. METHODS A retrospective cohort study of all consecutive patients who underwent thyroid and/or parathyroid surgery over a 7-year period was conducted. A nested case-control design was used to evaluate specific factors and their association with reoperation for bleeding. RESULTS Of 1913 patients, 25 (1.3%) underwent reoperation for bleeding. Of the 25 patients who bled, 6 (24%) required reoperation before leaving theatre; 17 (68%) had bleeding within 6 h, 1 (4%) between 6 and 24 h, and 1 (4%) after 24 h. Reoperation for bleeding was not associated with age, gender, or surgeon. Patients who had total thyroidectomy were more likely to have reoperation for bleeding compared to hemithyroidectomy (p = 0.045) or parathyroidectomy (p = 0.001). The following factors were not associated with bleeding: neck dissection, re-do surgery, drain use, blood-thinning medication or clotting disorders, and BMI. Patients who had reoperation for bleeding had longer hospital stay (p = 0.001), but similar rates of RLN palsy, wound infection, and hypoparathyroidism. CONCLUSION A higher risk profile for significant post-operative bleeding cannot be determined in patients undergoing thyroid surgery. Based on this experience, we developed protocols to reduce the risk of bleeding (the ITSRED Fred protocol) and for the early detection and management of bleed (the SCOOP protocol) following thyroid and/or parathyroid surgery.
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Affiliation(s)
- O Edafe
- Department of ENT, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - E Cochrane
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
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16
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Pallaske F, Seebauer C, Kaltofen D, Dziomber S, Rudolph H, Schwanebeck U, Grählert X, Schulze G, Pallaske A, Boese-Landgraf J, Schlömann M, Daeschlein G. Results of a randomised controlled trial between an ORC collagen hemostatic agent and a carrier-bound fibrin sealant. J Visc Surg 2020; 158:11-18. [PMID: 32747306 DOI: 10.1016/j.jviscsurg.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Despite ongoing optimisation of surgical techniques, hemostasis continues to be a fundamental challenge in many operations today. This randomised controlled trial compared the efficacy of a new hemostatic agent made of oxidised regenerated cellulose and collagen (ORC-Coll) with that of a conventional carrier-bound fibrin sealant (CBFS). METHODS Hemostasis was investigated representatively in the case of post-thyroidectomy bleeding from the resection surface. To demonstrate that ORC-Coll (mediCipio® A) has at least the same hemostatic efficacy as CBFS (Tachosil®), the volume of drainage fluid at the time of drain removal was used as the primary endpoint in a non-inferiority test with a significance level of 5%. The secondary endpoints included number and size of hemostatic agents required, adhesion of the hemostatic agent to the bleeding surface, intraoperative hemostatic effect, duration of drainage and adverse events during a six-month follow-up period. RESULTS A total of 150 patients (ORC-Coll: 75; CBFS: 75) were included. After operation, total volume of drainage fluid was 68.20±44.56mL in the ORC group and 68.21±40.20mL in the CBFS group. The non-inferiority of ORC-Coll compared to CBFS with regard to hemostatic efficacy was shown at a significance level of 5%. The results demonstrated effectiveness in achieving hemostasis without adverse events. CONCLUSIONS ORC-Coll is an effective hemostatic agent and barrier sealant without blood components, which ensures reliable prevention of intra- and postoperative bleeding. With use of the new technique, any risks associated with the use of human blood components are a priori eliminated.
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Affiliation(s)
- F Pallaske
- Medichema GmbH, Weststraße 57, 09112 Chemnitz, Germany.
| | - C Seebauer
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Walther-Rathenau Str. 42a, 17475 Greifswald, Germany.
| | - D Kaltofen
- General and Visceral Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany.
| | - S Dziomber
- General and Visceral Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany.
| | - H Rudolph
- General and Visceral Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany.
| | - U Schwanebeck
- Carl-Gustav-Carus Faculty of Medicine, Technische Universität Dresden, Coordinating Centre for Clinical Trials Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - X Grählert
- Carl-Gustav-Carus Faculty of Medicine, Technische Universität Dresden, Coordinating Centre for Clinical Trials Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - G Schulze
- Carl-Gustav-Carus Faculty of Medicine, Technische Universität Dresden, Coordinating Centre for Clinical Trials Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - A Pallaske
- Kreiskrankenhaus Stollberg gGmbH, Hospital of Internal Medicine II, Jahnsdorfer Straße 7, 09366 Stollberg, Germany.
| | - J Boese-Landgraf
- General and Visceral Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116 Chemnitz, Germany.
| | - M Schlömann
- Technische Universität Bergakademie Freiberg, Institute of Biosciences, 09599 Freiberg, Germany.
| | - G Daeschlein
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Walther-Rathenau Str. 42a, 17475 Greifswald, Germany.
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17
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Sekar S, Belavendra A, Jacob PM. Early Discharge and Selective Calcium Supplementation after Thyroidectomy Based on Post-Operative Day 1 Parathormone and Calcium Level: A Prospective Study. Indian J Endocrinol Metab 2020; 24:319-324. [PMID: 33088754 PMCID: PMC7540830 DOI: 10.4103/ijem.ijem_172_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Abstract
AIM This study aimed to evaluate a protocol using post thyroidectomy parathyroid hormone (PTH) levels on the day after surgery to facilitate early discharge of patients. METHODS This prospective observational study was done in Christian Medical College, India over 1 year with 125 consecutive patients who had serum PTH and calcium values measured in the morning following thyroidectomy/first postoperative day (D1). Patients with no symptoms and signs of hypocalcemia and with serum calcium ≥8 mg/dL and PTH ≥6 pg/ml according to the protocol were discharged without supplements on D1. Patients were followed up and tested for a week after surgery in the outpatient clinic to assess hypocalcemia and readmission rates. RESULTS Seventy five patients (60%) could be discharged early on D1without calcium supplementation; only one patient had mild hypocalcemia symptoms managed with oral calcium supplements during outpatient follow-up within 1 week and none who followed the protocol required readmission. Temporary biochemical hypocalcemia was encountered in 36 patients (28.8%) including symptomatic hypocalcemia in 13 patients (10.4%). Among the 36 patients with hypocalcemia, 26 patients (72.2%) had a PTH level <6 pg/ml. Three patients required intravenous calcium infusion to correct hypocalcemia. Sensitivity, specificity and positive predictive value, and ROC of PTH 6 pg/ml in predicting hypocalcemia were 70.5%, 94.5% and 83.3%, 0.86, respectively. The low PTH could also guide early supplementation of calcium and all the severe hypocalcemia patients had PTH lower than the cut off of 6 pg/ml. CONCLUSION A PTH and calcium-based protocol can be effectively used for early discharge of thyroidectomy patients the day after surgery without calcium supplementation. The compliance of the patient for early discharge was good.
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Affiliation(s)
- Suganya Sekar
- Department of Endocrine and Breast Surgery, Velammal Medical College and Research Centre, Madurai, Tamil Nadu, India
| | - Antonisamy Belavendra
- Department of Biostatistics and, Christian Medical College, Vellore, Tamil Nadu, India
| | - Paul M. Jacob
- Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Yekikian M, Ganry L, Fernandes R. Thyroid surgery outcomes analysis in an oral and maxillofacial surgery department. Int J Oral Maxillofac Surg 2019; 49:717-721. [PMID: 31874715 DOI: 10.1016/j.ijom.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to identify complication rates of thyroidectomies performed within the Department of Oral and Maxillofacial Surgery, University of Florida Health - Jacksonville, and to compare these with quantified data regarding complications of thyroidectomies performed by other specialties. A retrospective cohort analysis was implemented to determine complication rates amongst patients treated in the department between January 2012 and December 2017. Data variables included demographics, ASA status, social history, and preoperative signs and symptoms. The primary outcome variables were length of hospital length, secondary procedures in the same admission, and postoperative complications including hypocalcemia, hematoma, and voice changes. A total of 402 patients were identified, of whom six were excluded for insufficient data. The mean age of the 396 patients included was 47.9 years and 84.6% were female. Of the patients included, 338 experienced no complications; 86 patients spent more than one postoperative day in the hospital. A statistically significant (P=0.033) correlation was found between higher ASA status (III, IV, V) and increased length of stay. The results indicated safe and efficient thyroid surgery within a department of oral and maxillofacial surgery by current prevailing standards.
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Affiliation(s)
- Matthew Yekikian
- Department of Oral and Maxillofacial Surgery, University of Florida Health - Jacksonville, Jacksonville, Florida, USA.
| | - Laurent Ganry
- Department of Plastic and Maxillofacial Surgery, Faculty of Medicine, Sorbonne Université, Paris, France; Department of Plastic and Reconstructive Surgery, University Hospital of Armand-Trousseau, Paris, France.
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Health - Jacksonville, Jacksonville, Florida, USA.
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19
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Chen CY, Chiu YL, Rajbhandari S, Cheng SY, Lin HC, Chu YH, Lee JC. Predictive factors of increased surgical drain output after thyroid lobectomy: a retrospective study. Gland Surg 2019; 8:542-549. [PMID: 31741885 DOI: 10.21037/gs.2019.10.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Thyroid lobectomy is one of the most common operations for thyroid lesions. Life-threatening complications can occur; these include post-operative bleeding with airway compression caused by hematoma. Given this risk, prophylactic drains are routinely used in our practice. The aim of this study was to identify factors that influence the total drainage volume (TDV). Methods From 2016 to 2017, a total of 89 consecutive patients with thyroid lobectomy performed by the same surgeon were included in the study. The demographic characteristics of the patients, TDV, fine needle aspiration cytology, hospitalization day, operation time, thyroid gland size, and blood test results were retrospectively recorded from the hospital database. Spearman's rank correlation and multivariate regression were used to analyze the association of factors with the TDV. Results The median TDV was 56 mL, and there was a positive correlation between age, weight, blood sugar, gland size, hospitalization day, operation time, and TDV. Multivariate regression analysis revealed that male sex (β=19.684; 95% CI, 7.998-31.371; P=0.001), higher blood sugar (β=0.173; 95% CI, 0.087-0.260; P<0.001), and larger thyroid gland size (β=0.069; 95% CI, 0.008-0.130; P=0.027) were independent risk factors for TDV. Conclusions The TDV primarily depends on male sex, larger thyroid gland, and higher blood sugar level. Patients with these factors should undergo meticulous hemostasis and bleeding should be carefully monitored in the perioperative period.
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Affiliation(s)
- Chih-Yu Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei
| | - Sarina Rajbhandari
- Department of Otolaryngology-Head and Neck Surgery, Shankarapur Hospital, Kathmandu, Nepal
| | - Sheng-Yao Cheng
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hung-Che Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
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20
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Maroun CA, El Asmar M, Park SJ, El Asmar ML, Zhu G, Gourin CG, Fakhry C, Dhillon V, Tufano RP, Russell JO, Mandal R. Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma. Laryngoscope 2019; 130:1349-1356. [PMID: 31508818 DOI: 10.1002/lary.28269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/29/2019] [Accepted: 08/16/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To analyze the effect of drain placement on postoperative hematoma formation and other associated outcomes post-thyroid surgery in a large national cohort. METHODS This was a retrospective study that analyzed data from the 2016-2017 National Surgical Quality Improvement Program (NSQIP) public use files. Baseline characteristics and perioperative outcomes were compared between drain and no drain cohorts. RESULTS A total of 11,626 patients were included; 3281 had a drain placed intraoperatively and 8345 did not. Otolaryngologists were 6.98 times more likely to place a drain after thyroidectomy than general surgeons (P < .001), and patients undergoing subtotal or total thyroidectomy were 2.17 times more likely to have a drain placed than if undergoing partial thyroidectomy (P < .001). Drain placement did not reduce hematoma formation on both univariate and multivariate analyses (adjusted OR = 0.93, P = .696). A slightly larger proportion of patients underwent unplanned intubation postoperatively among those who had a drain placed (0.76% vs. 0.29%, P < .001). Patients who received a drain were on average 4.63 times as likely to remain in the hospital for 2 or more days compared to those who did not receive a drain. CONCLUSION Drain placement did not significantly affect postoperative hematoma formation following thyroidectomy. Drain placement should not be routinely employed in these patients. However, surgeon judgement and intraoperative considerations should be taken into account, as to when to place a drain. LEVEL OF EVIDENCE N/A Laryngoscope, 130:1349-1356, 2020.
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Affiliation(s)
- Christopher A Maroun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Margueritta El Asmar
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - So-Jin Park
- School of Medicine, University of Maryland, Baltimore, Maryland, U.S.A
| | - Marie Line El Asmar
- Gilbert and Rose-Marie Chagoury Health Sciences School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Gangcai Zhu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Vaninder Dhillon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, Maryland, U.S.A.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore, Maryland, U.S.A
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21
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Chow T, Kwan WW, Tsui CK, Yip VW, Chu CK, Njo AK, Lim H. Day surgery for total or completion thyroidectomy: The first report in Hong Kong. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tam‐Lin Chow
- Department of SurgeryUnited Christian Hospital Hong Kong
| | | | | | | | | | | | - Huey‐Sing Lim
- Anaesthesiology and Pain MedicineUnited Christian Hospital Hong Kong
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22
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Fan C, Zhou X, Su G, Zhou Y, Su J, Luo M, Li H. Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis. BMC Surg 2019; 19:98. [PMID: 31340806 PMCID: PMC6657038 DOI: 10.1186/s12893-019-0559-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 07/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to determine the risk factors associated with neck hematoma requiring surgical re-intervention after thyroidectomy. METHODS We systematically searched all articles available in the literature published in PubMed and CNKI databases through May 30, 2017. The quality of these articles was assessed using the Newcastle-Ottawa Quality Assessment Scale, and data were extracted for classification and analysis by focusing on articles related with neck hematoma requiring surgical re-intervention after thyroidectomy. Our meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS Of the 1028 screened articles, 26 met the inclusion criteria and were finally analyzed. The factors associated with a high risk of neck hematoma requiring surgical re-intervention after thyroidectomy included male gender (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.60-2.17, P < 0.00001), age (MD: 4.92, 95% CI: 4.28-5.56, P < 0.00001), Graves disease (OR: 1.81, 95% CI: 1.60-2.05, P < 0.00001), hypertension (OR: 2.27, 95% CI: 1.43-3.60, P = 0.0005), antithrombotic drug use (OR: 1.92, 95% CI: 1.51-2.44, P < 0.00001), thyroid procedure in low-volume hospitals (OR: 1.32, 95% CI: 1.12-1.57, P = 0.001), prior thyroid surgery (OR: 1.93, 95% CI: 1.11-3.37, P = 0.02), bilateral thyroidectomy (OR: 1.19, 95% CI: 1.09-1.30, P < 0.0001), and neck dissection (OR: 1.55, 95% CI: 1.23-1.94, P = 0.0002). Smoking status (OR: 1.19, 95% CI: 0.99-1.42, P = 0.06), malignant tumors (OR: 1.00, 95% CI: 0.83-1.20, P = 0.97), and drainage used (OR: 2.02, 95% CI: 0.69-5.89, P = 0.20) were not significantly associated with postoperative neck hematoma. CONCLUSION We identified certain risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy, including male gender, age, Graves disease, hypertension, antithrombotic agent use, history of thyroid procedures in low-volume hospitals, previous thyroid surgery, bilateral thyroidectomy, and neck dissection. Appropriate intervention measures based on these risk factors may reduce the incidence of postoperative hematoma and yield greater benefits for the patients.
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Affiliation(s)
- Chunlei Fan
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Xin Zhou
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Guoqiang Su
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China.
| | - Yanming Zhou
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jingjun Su
- Department of Ultrasound, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China.
| | - Mingxu Luo
- Department of Gastrointestinal Surgery III, Xiamen Cancer Hospital, First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China
| | - Hui Li
- Department of Hepatic Surgery and Liver transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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23
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Erdas E, Medas F, Sanna S, Gordini L, Pisano G, Canu GL, Calò PG. Does antithrombotic prophylaxis worsen early outcomes of total thyroidectomy? - a retrospective cohort study. BMC Surg 2019; 18:82. [PMID: 31074394 PMCID: PMC7402577 DOI: 10.1186/s12893-018-0407-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Currently, there is no strong evidence on the effectiveness and safety of pharmacological antithrombotic prophylaxis in thyroid surgery. The aim of this study was to establish whether the prophylactic use of low-molecular-weight heparin (LMWH) could negatively affect the early outcomes of patients undergoing total thyroidectomy. Methods Data from patients submitted to total thyroidectomy between February 2013 and October 2017 were retrospectively collected and analysed. Only patients with indication to antithrombotic prophylaxis according to current guidelines were included in the study. Eligible cases were divided into two groups, which corresponded to two distinct periods of our surgical practice: Group A, which included 178 consecutive patients who were submitted to antithrombotic prophylaxis with LMWH, and Group B, which included 348 consecutive patients who did not receive prophylaxis. Primary endpoints were the incidence of post-operative cervical haematomas (POCH) and thromboembolic events. Secondary endpoint was the length of postoperative hospital stay. Statistical analysis was performed by using Student’s t test for continuous variables and Chi-square test for categorical variables. A P value of less than 0.05 was considered statistically significant. Results The two groups of patients were comparable in terms of age, gender, thyroid disease, duration of surgery, and weight of the thyroid gland. Overall, no thromboembolic events were registered. The comparative analysis of the other outcome measures, showed no significant differences between the two groups (POCH: 2 cases (1.12%) in Group A vs 8 cases (2.30%) in Group B - p 0.349; Postoperative hospital stay: 2.90 ± 0.86 days in Group A vs 2.89 ± 0.99 days in Group B - p 0.908). Conclusions Data from this study do not support or contraindicate the use of antithrombotic prophylaxis in thyroid surgery. However, since thyroidectomy is a closed-space procedure, and even modest bleeding may quickly result in airway compression and death by asphyxia, mechanical prophylaxis should be preferred to LMWH whenever possible. Trial registration ISRCTN ISRCTN12029395. Registered 05/02/2018 retrospectively registered.
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Affiliation(s)
- E Erdas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy.
| | - F Medas
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - S Sanna
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - L Gordini
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - G Pisano
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - G L Canu
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042, Monserrato, CA, Italy
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Kunduz E, Aysan E, İdiz UO, Ersoy YE, Bektaşoğlu HK, Yığman S, Kundakcıoğlu H. Evaluation of local hemostatic effect of microporous polysaccharide hemospheres products in thyroid surgery: a prospective randomized controlled study. Turk J Surg 2019; 35:49-53. [PMID: 32550303 DOI: 10.5578/turkjsurg.4162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022]
Abstract
Objectives Bleeding is a rare and dangerous complication of thyroid surgery. One of the hemostatic agents used during surgery are microporous polysaccharide hemospheres (MPH) which are local hemostatic agents acquired from purified potato starch. The aim of this study was to evaluate the efficiency of two MPH, produced with different biotechniques, in decreasing hemorrhages and drainage following thyroidectomy. Material and Methods A statistical power analysis predicted that totally 20 patients per each group was needed within 95% confidential interval. Patients were randomized into 3 groups as control, Haemocer TM and Arista TM to be 20 patients in each group. Following bilateral total thyroidectomy, no additional procedures were performed in the first group, 5 g Haemocer was administered to the second group, 5 g Arista was administered to the third group into the operational field, and the operation was ended by placing a double-sided hemovac drain. At post-operative day one, drainage amount, calcium (Ca), phosphate (P) and parathyroid hormone (PTH) levels were noted. Results No significant difference was noted between the groups for age, gender, removed tissue weight and malignant pathology rates. Also, no significant difference was noted between post-operative drainages and Ca, P, PTH levels of groups either. Hoarseness or hematoma were not observed in any patient. Conclusion MPHs are not proven in effectiveness in decreasing post-operative hemorrhages, which might be a key to avoiding unnecessary expenses.
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Affiliation(s)
- Enver Kunduz
- Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
| | - Erhan Aysan
- Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
| | - Ufuk Oğuz İdiz
- İstanbul Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul, Türkiye
| | - Yeliz Emine Ersoy
- Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
| | | | - Samet Yığman
- Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
| | - Hacer Kundakcıoğlu
- Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İstanbul, Türkiye
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Talutis SD, Drake FT, Sachs T, Rao SR, McAneny D. Evacuation of postoperative hematomas after thyroid and parathyroid surgery: An analysis of the CESQIP Database. Surgery 2019; 165:250-256. [DOI: 10.1016/j.surg.2018.04.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/10/2018] [Accepted: 04/25/2018] [Indexed: 10/27/2022]
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Khadra H, Bakeer M, Hauch A, Hu T, Kandil E. Hemostatic agent use in thyroid surgery: a meta-analysis. Gland Surg 2018; 7:S34-S41. [PMID: 30175062 DOI: 10.21037/gs.2018.03.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The use of hemostatic agents in thyroid surgery has been widely reported in the literature. The aim of this study is to assess the safety and efficacy of hemostatic agents in comparison to conventional techniques for hemostasis by meta-analysis of the current literature. Methods Articles were identified from PubMed and EMBASE using the following keyword searches: "hemostatic agent and thyroid surgery" and "hemostatic agent and thyroidectomy". Outcomes included total operative time, estimated blood loss, length of hospital stay, and intraoperative and postoperative complications. Data were extracted following review of appropriate studies by two independent authors and outcome differences were calculated using analysis of variance and the Bonferroni method. Results Thirty-four publications were identified and 10 studies met our inclusion criteria, totaling 941 patients, 519 (55.1%) of which received a hemostatic agent during thyroid surgery. Of these patients who had hemostatic agents, 369 (71%) received a hemostatic gel and 150 (29%) received an oxidized cellulose patch. Outcome measures in each of these groups were compared with the patients receiving only conventional methods of hemostasis. The risk of hematoma formation in the hemostatic gel group was comparable to conventional hemostatic methods (95% CI: 0.33, 2.59). This was also true when comparing conventional hemostasis to the patch (95% CI: 0.64, 15.24). No difference in the risk for seroma formation was found between the conventional and hemostatic gel groups (95% CI: 0.26, 3.95). Drain output was significantly less in the gel group 40.75±35.6 mL compared to 66.26±31.2 mL in the conventional group (95% CI: -23.422, -7.460). Patients who received hemostatic agents had shorter hospital stays when compared to the conventional group (95% CI: -1.057, -0.203). Conclusions Our meta-analysis suggests that the use of a hemostatic agent in thyroid surgery yields minimal advantages for the management of perioperative bleeding risk.
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Affiliation(s)
- Helmi Khadra
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mohamed Bakeer
- Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Adam Hauch
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Schopf S, von Ahnen T, von Ahnen M, Schardey HM, Wirth U. New insights into the pathophysiology of postoperative hemorrhage in thyroid surgery: An experimental study in a porcine model. Surgery 2018; 164:518-524. [PMID: 30029990 DOI: 10.1016/j.surg.2018.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Postoperative cervical hemorrhage is a rare but life-threatening complication that can cause severe morbidity. Different mechanisms leading to asphyxia have been described based only on clinical observation. METHODS We performed a series of in vivo animal studies simulating post-thyroidectomy hemorrhage and its effect on respiratory drive. Three series of tests were carried out in 12 German domestic pigs under general anesthesia. The pigs were breathing spontaneously with secured airways. An additional series using functional magnetic resonance imaging of the pigs' brainstem was also conducted. RESULTS The first experimental series carried out on 2 animals revealed an obvious difference between the effects of cervical hemorrhage and external bleeding with development of hemorrhagic shock. An experimental setting for the repeated simulation of cervical hemorrhage was established. A pressure-dependent mechanism was discovered that led to apnea in every animal despite the secured airway. In 8 of 10 animals, relief of cervical pressure led to complete respiratory recovery. The test was repeated up to 6 times per pig. Apnea was induced in 25 of 25 test procedures (100%) and was followed by respiratory recovery in 22 of 25 tests (88%). The threshold pressure at which the respiratory rate started to decrease was 47 ± 14 Torr when blood was used to increase the cervical compartment pressure. When silicone oil was used in a further experimental series, the threshold pressure was similar at 44 ± 21 Torr. The cervical compartment pressure needed to induce apnea was 74 ± 18 Torr using blood and 74 ± 39 Torr using silicone oil, both of which exceeded the mean arterial pressure by 28 Torr during apnea. Functional magnetic resonance imaging revealed a decrease in brainstem activity during phases of increased cervical compartment pressure, which suggests a possible role for cerebral vascular perfusion. CONCLUSION Respiratory drive can be suppressed by increased pressure in the cervical compartment, possibly because of a pressure-dependent impairment in cerebral perfusion through a form of cervical compartment phenomenon or, less likely, a pressure-dependent reflex (nervous) mechanism.
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Affiliation(s)
- Stefan Schopf
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Thomas von Ahnen
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Martin von Ahnen
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Hans Martin Schardey
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Ulrich Wirth
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany; Department of General, Visceral and Transplantation Surgery, University Hospital Ludwig-Maximilians University Munich, Munich, Germany.
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Aleksandar K, Miodagl D, Nebojsa D, Ilija G. Effect of fibrin vs cellulose based haemostatic agents with traditional haemostatic procedures in thyroid surgery. Pak J Med Sci 2018; 33:1360-1365. [PMID: 29492059 PMCID: PMC5768825 DOI: 10.12669/pjms.336.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To compare the efficacy of fibrin-based hemostat and cellulose-based hemostat with traditional procedures in patients undergoing thyroid surgery. Methods: Between January 2012 and December 2016, 255 patients were scheduled to undergo total thyroidectomy at Surgical Clinic Nis. The patients were randomized to: Group-I use of classic surgical procedures to achieve hemostasis, Group-II use Surgicel and Group-III use Beriplas Results: A statistically significant reduction of surgical time was found for Group-I compared with Group-II and III (p≤0.01 for both groups). Statistically significant reduction of intraoperative blood loss was found for Group-I compared with Group-II from 102.3mL vs. 86.1mL (p≤0.01) as well as compared to Group-III (mean 77.4mL, p≤0.01). Removal of the wound drain occurred sooner in the Group-II and III compared with Group-I (mean 37.1h vs. 40.1h, p≤0.05; mean 31.2h vs. 40.1h, p≤0.01). There were no significant differences in terms of postoperative morbidity among the groups. Conclusions: Fibrin based haemostat seems to be an effective hemostatic agent for patients undergoing thyroid surgery. We suggest that, where appropriate, this fibrin-based haemostat should be used as a first line hemostatic agent in thyroidectomy in combination with conventional surgical means of hemostasis.
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Affiliation(s)
- Karanikolic Aleksandar
- Dr. Karanikolic Aleksandar, MD, PhD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Djordjevic Miodagl
- Dr. Djordjevic Miodag, MD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Djordjevic Nebojsa
- Prof. Dr. Djordjevic Nebojsa, MD, PhD. Medical Faculty Nis, University of Nis, Serbia. Surgical Clinic, Clinical center Nis, Serbia
| | - Golubovic Ilija
- Dr. Golubovic Ilija MD. Surgical Clinic, Clinical center Nis, Serbia
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Wirth U, von Ahnen T, Schopf S, Schardey HM. Postoperative Continuous Pressure Monitoring in Thyroid Surgery: Pathophysiology of Post-Thyroidectomy Hemorrhage. VideoEndocrinology 2018. [DOI: 10.1089/ve.2017.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ulrich Wirth
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
- Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich, Munich, Germany
| | - Thomas von Ahnen
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Stefan Schopf
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
| | - Hans Martin Schardey
- Department of General and Vascular Surgery, Agatharied Hospital, Hausham, Germany
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Wojtczak B, Aporowicz M, Kaliszewski K, Bolanowski M. Consequences of bleeding after thyroid surgery - analysis of 7805 operations performed in a single center. Arch Med Sci 2018; 14:329-335. [PMID: 29593806 PMCID: PMC5868671 DOI: 10.5114/aoms.2016.63004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Beata Wojtczak
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Aporowicz
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Bolanowski
- Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Li L, Chen H, Tao H, Liu W, Li W, Leng Z, Zhao E, Huang T. The effect of no drainage in patients who underwent thyroidectomy with neck dissection: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e9052. [PMID: 29390300 PMCID: PMC5815712 DOI: 10.1097/md.0000000000009052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the effect of no drainage in patients who underwent thyroidectomy and neck lymph node dissection. METHODS We followed the methodological standard expected by Cochrane. We searched the following databases by March 23, 2017: PubMed, The Cochrane Library, EMBASE via Ovid SP, and Medline via Ovid SP. Two reviewers screened the studies and extracted the data. Randomized controlled trials (RCTs) or nonrandomized interventional studies assessing the effect of no drainage following thyroidectomy with lymph node dissection were included. RESULTS Three studies with 387 participants were included. There was no statistical difference between groups for the overall perioperative complications (2 RCTs, n = 234, RR 1.56, 95% CI 0.53-4.64), or specific complications such as seroma (2 RCTs, n = 234, RR 1.81, 95% CI 0.46-7.07), hematoma (2 RCTs, n = 234, RR 0.72, 95% CI 0.11-4.83) or hemorrhage (1 RCT, n = 69, RR 0.29, 95% CI 0.01-6.87). One case required reoperation due to hemorrhage in the drainage group was reported in 1 study (n = 32). No mortality was reported. Two studies (n = 234) stated a longer hospital stay in the drainage group than that in the group without drainage. There was moderate or serious bias for the risk of bias of included studies. CONCLUSION The effect of no-drainage in patients with thyroid cancer who received thyroidectomy with neck dissections remains uncertain, since there are very few studies that addressed the question. Drainage may lead to longer hospital stay than nondrainage. More randomized or nonrandmized studies are required to address this issue.
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Affiliation(s)
- Lei Li
- Department of Breast and Thyroid Surgery
| | | | | | - Weizhen Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Wenrong Li
- Department of Acupuncture and Manipulation Therapy, Laixi Hospital of Chinese Traditional Medicine, Laixi, Qingdao, Shandong, China
| | - Zhengwei Leng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Ende Zhao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei
| | - Tao Huang
- Department of Breast and Thyroid Surgery
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Liu J, Sun W, Dong W, Wang Z, Zhang P, Zhang T, Zhang H. Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol 2017; 176:591-602. [PMID: 28179452 DOI: 10.1530/eje-16-0757] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/05/2017] [Accepted: 02/07/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Post-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage. METHODS The PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data. RESULTS Twenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09-5.52, P < 0.00001), male sex (OR = 1.73, 95% CI = 1.54-1.94, P < 0.00001), Graves' disease (OR = 1.76, 95% CI = 1.44-2.15, P < 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55-2.49, P < 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50-1.96, P < 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11-2.11, P = 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12-2.34, P = 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89-1.28, P = 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74-2.18, P = 0.4) were not associated with post-thyroidectomy haemorrhage. CONCLUSION Our systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves' disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.
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Affiliation(s)
- Jinhao Liu
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Wei Sun
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Wenwu Dong
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zhihong Wang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ping Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ting Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Hao Zhang
- Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Al-Habsi AS, Al-Sulaimani AAK, Taqi KM, Al-Qadhi HA. Comparison of Postoperative Drain Insertion versus No Drain Insertion in Thyroidectomies: Retrospective case-control study from the Sultan Qaboos University Hospital, Muscat, Oman. Sultan Qaboos Univ Med J 2016; 16:e464-e468. [PMID: 28003893 DOI: 10.18295/squmj.2016.16.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/11/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES A thyroidectomy is a frequently performed surgical procedure which can result in life-threatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes. METHODS This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated. RESULTS During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female (87.2%). Drains were inserted postoperatively after 202 surgeries (80.8%) compared to 48 surgeries (19.2%) without drains. A total of 32 surgeries (12.8%) were conducted on patients with thyroid masses <1 cm, 138 (55.2%) on those with masses between 1-4 cm and 80 (32.0%) on those with masses >4 cm. The association between drain use and mass size was not significant (P = 0.439). Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant (P >0.050). Length of hospital stay was significantly longer among patients with postoperative drains (P <0.010). CONCLUSION The routine insertion of drains after thyroid surgeries was found to result in longer hospital stays and did not reduce rates of post-thyroidectomy complications. Thyroid mass size should not be used as an indicator for the insertion of a drain after thyroidectomy.
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Affiliation(s)
- Asma S Al-Habsi
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Al-Anood K Al-Sulaimani
- Department of Surgery, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Kadhim M Taqi
- General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Hani A Al-Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Merki V, Pichler J, Giger R, Mantokoudis G. Chylothorax in thyroid surgery: a very rare case and systematic review of the literature. J Otolaryngol Head Neck Surg 2016; 45:52. [PMID: 27756377 PMCID: PMC5070362 DOI: 10.1186/s40463-016-0166-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Chylothorax is a very rare but major complication in thyroid surgery and should be apparent to clinicians in this field. Case presentation We report a case with chylothrax after thyroid surgery in our department that drew our attention. Methods Systematic review of the literature to evaluate the incidence and the contributing factors of chylothorax after thyroid surgery. Database (PubMed) and hand searches to identify patients with thyroid surgery and postoperative chylothorax. Keywords included chylothorax, thyroidectomy, thyroid surgery and complications. Two independent reviewers screened studies against inclusion and exclusion criteria. Patient characteristics, risk factors, symptoms, treatments and etiopathogenesis were investigated. Results We identified 13 articles in the literature describing 19 patients with chylothorax after thyroidectomy and described our own case. Ninety percent of the patients underwent thyroidectomy for thyroid cancer. Sixteen patients (80 %) underwent thyroidectomy with at least a left lateral neck dissection, 2 patients (10 %) underwent thyroidectomy with sternotomy, and in the remaining 2 patients (10 %), thyroidectomy with lateral neck dissection on both sides was performed with partial sternotomy. Our calculated incidence for chylothorax with total thyroidectomy and neck dissection was 1.85 %; for a thoracic approach the calculated incidence was 7.3 %. Conclusions There are no reports of chylothorax after thyroidectomy without at least a left lateral neck dissection due to advanced thyroid cancer and/or sternotomy due to the thyroid size. The extension of thyroid surgery seems to be the main risk factor in developing chylothorax either through direct surgical trauma or through increased intraductal pressure after thoracic duct ligation. An early diagnosis of chylothorax may avoid severe metabolic or cardiopulmonary complications.
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Affiliation(s)
- Verena Merki
- Department of Otorhinolaryngology-Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland
| | - Juliane Pichler
- Department of Otorhinolaryngology-Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology-Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland.
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology-Head & Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, 3010, Bern, Switzerland
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Quimby AE, Wells ST, Hearn M, Javidnia H, Johnson-Obaseki S. Is there a group of patients at greater risk for hematoma following thyroidectomy? A systematic review and meta-analysis. Laryngoscope 2016; 127:1483-1490. [DOI: 10.1002/lary.26195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | - Simon T. Wells
- Faculty of Medicine; University of Ottawa; Ontario Canada
| | - Matthew Hearn
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ontario Canada
| | - Hedyeh Javidnia
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ontario Canada
- The Ottawa Hospital; Ottawa Ontario Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ontario Canada
- The Ottawa Hospital; Ottawa Ontario Canada
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Rosato L, De Crea C, Bellantone R, Brandi ML, De Toma G, Filetti S, Miccoli P, Pacini F, Pelizzo MR, Pontecorvi A, Avenia N, De Pasquale L, Chiofalo MG, Gurrado A, Innaro N, La Valle G, Lombardi CP, Marini PL, Mondini G, Mullineris B, Pezzullo L, Raffaelli M, Testini M, De Palma M. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2016; 39:939-53. [PMID: 27059212 DOI: 10.1007/s40618-016-0455-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/08/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. METHODS This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. RESULTS A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. CONCLUSIONS The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO4, Ivrea Hospital, School of Medicine, Turin University, Turin, Italy
| | - C De Crea
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy.
| | - R Bellantone
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M L Brandi
- Clinical Unit on Metabolic Bone Disorders, University Hospital of Florence, Florence, Italy
| | - G De Toma
- Endocrine Surgery, Department of Surgery "P. Valdoni", "La Sapienza" University, Rome, Italy
| | - S Filetti
- Department of Clinical Sciences, "La Sapienza" University, Rome, Italy
| | - P Miccoli
- Endocrine Surgery, Department of Surgery, Pisa University, Rome, Italy
| | - F Pacini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - M R Pelizzo
- Endocrine Surgery, Department of Surgery, Padua University, Padua, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University, Rome, Italy
| | - N Avenia
- Department of Surgery, "S. Maria" Terni Hospital, Perugia University, Perugia, Italy
| | - L De Pasquale
- Endocrine and Breast Surgical Unit, Department of Surgery, "S. Paolo" Hospital, Milan, Italy
| | - M G Chiofalo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - A Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - N Innaro
- Endocrine Surgery, Department of Surgery, "Mater Domini" Hospital, Catanzaro, Italy
| | - G La Valle
- Health Management, Piedmont Region, ASL TO4, School of Medicine, Turin University, Turin, Italy
| | - C P Lombardi
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - P L Marini
- Endocrine Surgery, Department of Surgery, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - G Mondini
- General Surgery, Endocrine and Breast Surgical Unit, Department of Surgery, ASL TO4, Ivrea Hospital, Turin, Italy
| | - B Mullineris
- General Surgery and Endocrine Surgical Unit, Department of Surgery, Sant'Agostino-Estense NOCSAE, Modena, Italy
| | - L Pezzullo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - M Raffaelli
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - M De Palma
- Department of Surgery, A.O.R.N. "Cardarelli" Hospital, Naples, Italy
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Christakis IA, Potylchansky E, Silva AM, Nates JP, Prieto PA, Graham PH, Grubbs EG, Lee JE, Perrier ND. Cervical hematoma following an endocrine surgical procedure: The MD Anderson experience. Surgery 2016; 160:377-83. [PMID: 27063343 DOI: 10.1016/j.surg.2016.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Airway compromise from postoperative neck hematoma remains the most feared complication after cervical endocrine operative procedures. Events are rare and potentially lethal, and clear multidisciplinary guidelines for management of these patients are lacking. The aim of our study was to review the experience of a tertiary cancer center in this scenario. METHODS Data prospectively collected over a 10-year period, between 2005 and 2014, were retrospectively analyzed. We included all adult patients who had had a neck operation and needed reoperation for postoperative neck hematoma after an endocrine procedure. We excluded pediatric patients and cases with incomplete records. RESULTS The inclusion criteria were met for 21 patients (21/2,930; 0.7%). The median age at operation was 56.2 years (SD: 16.7). The M:F ratio was 1:2. All 21 patients presented with a neck swelling at the time of reoperation. Eight of 21 patients (38%) underwent emergency bedside clot evacuation. Presentation was within 6 hours for two thirds (14/21) of the patients; the remaining one third of the patients had the hematoma develop during the evening/night (from 1700-0500). The mean estimated hematoma size was 98 cc (SD: 58). A source of bleeding was identified in 12 of 21 cases (57%). A total of 15.8% of patients had an airway classified as difficult/awkward under the American Society of Anesthesiologists classification for their wound re-exploration. CONCLUSION Postoperation, increased vigilance is needed for the first 6 hours to detect patients with neck swelling. Emergency drainage by the bedside was performed in 38% of patients. A difficult airway was uncommon in our series.
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Affiliation(s)
- Ioannis A Christakis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elena Potylchansky
- Department of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angelica M Silva
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph P Nates
- Department of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter A Prieto
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Tartaglia N, Di Lascia A, Lizzi V, Cianci P, Fersini A, Ambrosi A, Neri V. Haemostasis in Thyroid Surgery: Collagen-Fibrinogen-Thrombin Patch versus Cellulose Gauze-Our Experience. Surg Res Pract 2016; 2016:3058754. [PMID: 27018148 PMCID: PMC4785271 DOI: 10.1155/2016/3058754] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 02/08/2023] Open
Abstract
Purpose. Postoperative hemorrhage is fortunately uncommon but potentially life-threatening complication of thyroid surgery that increases the postoperative morbidity and the hospital stay. In this study we compare the efficacy of collagen patch coated with human fibrinogen and human thrombin (CFTP) (group C) and oxidized regenerated cellulose gauze (group B) versus traditional hemostatic procedures (group A) in thyroid surgery. Methods. From January 2011 to December 2013, 226 were eligible for our prospective, nonrandomized, comparative study. Patients requiring a video-assisted thyroidectomy without drain, "near total," or hemithyroidectomy were excluded. Other exclusion criteria were a diagnosis of malignancy, substernal goiter, disorders of hemostasis or coagulation, and Graves or hyperfunctioning thyroid diseases. Outcomes included duration of operation, drainage volume, and postoperative complications. Results. Our results show a significant reduction in drainage volume in group C in comparison with the other two groups. In group C there was no bleeding but the limited numbers do not make this result significant. There were no differences in terms of other complications, except for the incidence of seroma in group B. Conclusion. The use of CFTP reduces the drainage volume, potentially the bleeding complications, and the hospital stay. These findings confirm the efficacy of CFTP, encouraging its use in thyroid surgery.
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Affiliation(s)
- Nicola Tartaglia
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
- *Nicola Tartaglia:
| | - Alessandra Di Lascia
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
| | - Vincenzo Lizzi
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
| | - Pasquale Cianci
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
| | - Alberto Fersini
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
| | - Vincenzo Neri
- Department of Medical and Surgical Science, University of Foggia, Luigi Pinto Street 1, 71122 Foggia, Italy
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Risk factors for post-thyroidectomy haematoma. The Journal of Laryngology & Otology 2015; 130 Suppl 1:S20-5. [DOI: 10.1017/s0022215115003199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:There has been increasing emphasis on performing ‘same-day’ or ‘out-patient’ thyroidectomy to reduce associated costs. However, acceptance has been limited by the risk of potentially life-threatening post-operative bleeding. This study aimed to review current rates of post-operative bleeding in a metropolitan teaching hospital and identify risk factors.Method:Medical records of patients undergoing thyroidectomy between January 2007 and March 2012 were reviewed retrospectively. Pre-operative, operative and pathological data, and post-operative complication data, were examined.Results:The study comprised 205 thyroidectomy cases. Mean age was 51.6 years (standard deviation = 14.74), with 80 per cent females. Unilateral thyroidectomy was performed in 81 cases (39.5 per cent) and total thyroidectomy was performed in 74 cases (36.1 per cent; 5.3 per cent with concomitant lymph node dissection). Nine patients (4.4 per cent) suffered post-operative bleeding, of which six required re-operation. Analysis showed that post-operative systolic blood pressure of 180 mmHg or greater was associated with post-operative bleeding (p = 0.003, chi-square test).Conclusion:Rates of significant post-operative bleeding are consistent with recent literature. Post-operative hypertension, diabetes and high post-operative drain output were identified as independent risk factors on multivariate analysis; when identified, these may be caveats to same-day discharge of thyroidectomy patients.
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Samona S, Hagglund K, Edhayan E. Case cohort study of risk factors for post-thyroidectomy hemorrhage. Am J Surg 2015; 211:537-40. [PMID: 26778765 DOI: 10.1016/j.amjsurg.2015.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/22/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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.
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Affiliation(s)
- Scott Samona
- General Surgery Department, St. John Hospital and Medical Center, 22151 Moross Road, PB 1, Suite 212, Detroit, MI 48236, USA
| | - Karen Hagglund
- General Surgery Department, St. John Hospital and Medical Center, 22151 Moross Road, PB 1, Suite 212, Detroit, MI 48236, USA
| | - Elango Edhayan
- General Surgery Department, St. John Hospital and Medical Center, 22151 Moross Road, PB 1, Suite 212, Detroit, MI 48236, USA
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Dehal A, Abbas A, Hussain F, Johna S. Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database. Perm J 2015; 19:22-8. [PMID: 25663203 DOI: 10.7812/tpp/14-085] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Postoperative neck hematoma is a well-known complication of thyroid and parathyroid surgery. Better understanding of risk factors for hematoma formation will help define high-risk populations. OBJECTIVE To examine possible risk factors for neck hematoma after thyroid or parathyroid surgery. DESIGN Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample database. METHODS Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedures codes, we identified adults who underwent thyroid or parathyroid surgery and in whom neck hematoma subsequently developed. Information about demographic, clinical, and hospital characteristics was collected. Multivariate regression analyses were used to predict independent risk factors for neck hematoma. RESULTS We identified 147,344 thyroid and parathyroid operations performed nationwide between 2000 and 2009. Overall incidence of postoperative neck hematoma was 1.5% (n = 2210). In multivariate analysis, age 65 years and older (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.4-2.1), male sex (OR = 1.3, 95% CI = 1.2-1.4), African-American race (OR = 1.5, 95% CI = 1.2-1.7), being from the South (OR = 1.3, 95% CI = 1-1.4), comorbidity score of 3 or more (OR = 2, 95% CI = 1.6-2.6), history of alcohol abuse (OR = 2.7, 95% CI = 1.6-2.5), Graves disease (OR = 3, 95% CI = 2.1-4.1), and substernal thyroidectomy (OR = 3.3, 95% CI = 2.8-3.9) were associated with a higher risk of neck hematoma. CONCLUSION We identified demographic and clinical factors associated with increased risk of neck hematoma after thyroid or parathyroid surgery.
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Affiliation(s)
- Ahmed Dehal
- Resident at the Fontana Medical Center in CA.
| | - Ali Abbas
- Resident at Shands Hospital at the University of Florida in Gainesville.
| | - Farabi Hussain
- General Surgeon at the Arrowhead Regional Medical Center in Colton, CA.
| | - Samir Johna
- General Surgeon at the Fontana Medical Center in CA.
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Erdas E, Medas F, Podda F, Furcas S, Pisano G, Nicolosi A, Calò PG. The use of a biologic topical haemostatic agent (TachoSil(®)) for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroid surgery: A randomised controlled pilot trial. Int J Surg 2015; 20:95-100. [PMID: 26079499 DOI: 10.1016/j.ijsu.2015.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/17/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Anticoagulants and antiplatelet agents are well-known risk factors for post-operative bleeding. The aim of this prospective, randomized pilot study was to evaluate the effectiveness of a topical haemostatic agent, namely TachoSil, for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroidectomy. Perioperative management and some distinctive aspects of cervical haematomas were also discussed. METHODS Between January 2012 and May 2014, all patients taking vitamin K antagonists (VKAs) or acetyl salicylic acid (ASA) scheduled for total thyroidectomy were enrolled and randomly allocated to group 1 (standard haemostasis) and group 2 (standard haemostasis + TachoSil). Antithrombotic drugs were always suspended prior to surgery and, when indicated, replaced by bridging anticoagulation with low-molecular-weight heparin. The primary endpoint was the incidence of postoperative cervical haematomas. RESULTS A total of 70 patients were included in the study, representing 8.5% (70/820) of all patients who underwent thyroidectomies in the same period. The overall rate of post-operative cervical haematoma was 7.1% (5/70) and reached 14.8% (4/27) in patients on VKA therapy. All but one occurred more than 24 h after surgery (32nd hour, 8th, 10th, and 13th days). Group 1 (37 patients) and group 2 (33 patients) were well-matched according to clinical and demographic features. Postoperative haematoma was observed in 2/37 patients (5.4%) recruited in the Group 1 and 3/33 patients (9.1%) recruited in the Group 2 (P = 0.661). CONCLUSIONS Patients taking antithrombotic drugs represent a major problem in thyroid surgery. The incidence of bleeding after thyroidectomy is significantly high and the use of TachoSil do not seem effective in preventing its occurrence. However, larger multicenter study is needed to confirm these results.
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Affiliation(s)
- Enrico Erdas
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy.
| | - Fabio Medas
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
| | - Francesco Podda
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
| | - Silvia Furcas
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
| | - Giuseppe Pisano
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
| | - Angelo Nicolosi
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
| | - Pietro Giorgio Calò
- Chirurgia Generale A, Policlinico Universitario di Monserrato, AOU di Cagliari, Italy
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Ahnen TV, Ahnen MV, Wirth U, Schroll A, Schardey HM, Schopf S. Pathophysiology of airway obstruction caused by wound hematoma after thyroidectomy: an ex vivo study. Eur Surg 2015. [DOI: 10.1007/s10353-015-0318-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ahnen TV, Ahnen MV, Wirth U, Barisic A, Schardey HM, Schopf S. Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot<sup>®</sup>) with Conventional Haemostatic Procedure after Thyroid Resection. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ss.2015.66037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee JS, Choi SH, Kang YR, Kim Y, Shim YH. Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial. Can J Anaesth 2014; 62:392-8. [DOI: 10.1007/s12630-014-0295-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022] Open
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Parate LH, Pujari VS, Anandaswamy TC, Vig S. Post- thyroidectomy haematoma causing severe supraglottic oedema and pulmonary oedema - a case report. J Clin Diagn Res 2014; 8:GD01-2. [PMID: 25300409 DOI: 10.7860/jcdr/2014/9012.4745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/01/2014] [Indexed: 11/24/2022]
Abstract
Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy haematoma is a rare but life threatening complication of thyroid surgery leading to airway obstruction. We report a case of huge goiter that underwent near total thyroidectomy and developed post thyroidectomy haematoma. Within no time it resulted in near fatal airway obstruction, pulmonary oedema and cardiac arrest. The haematoma was evacuated immediately and patient was resuscitated successfully. Pulmonary oedema was further worsened by subsequent aggressive fluid resuscitation. She was electively ventilated with PEEP and was extubated after five days. Except for right vocal cord palsy her postoperative stay was uneventful. This is unique case where a post thyoidectomy haematoma has resulted in fatal supraglottic oedema and pulmonary oedema. Early recognition, immediate intubation and evacuation of haematoma are the key to manage this complication. We highlight on the pathophysiology of haematoma and discuss the strategies to prevent similar events in future.
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Affiliation(s)
- Leena Harshad Parate
- Assistant Professor, Department of Anaesthesia, M.S. Ramaiah Medical College , Bangalore, Karnataka, India
| | - Vinayak Seenappa Pujari
- Associate Professor, Department of Anaesthesia, M.S. Ramaiah Medical College , Bangalore, Karnataka, India
| | - Tejesh C Anandaswamy
- Assosciate Professor, Department of Anaesthesia, M.S. Ramaiah Medical College , Bangalore, Karnataka, India
| | - Saurabh Vig
- Junior Resident, Department of Anaesthesia, M.S. Ramaiah Medical College , Bangalore, Karnataka, India
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Dehal A, Abbas A, Al-Tememi M, Hussain F, Johna S. Impact of Surgeon Volume on Incidence of Neck Hematoma after Thyroid and Parathyroid Surgery: Ten Years’ Analysis of Nationwide In-patient Sample Database. Am Surg 2014. [DOI: 10.1177/000313481408001008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study's objective is to examine the impact of surgeon experience on the incidence and the severity of neck hematoma after thyroid and parathyroid surgery using a nationwide database. The Nationwide In-patient Sample is a nationwide clinical and administrative database. We used the International Classification of Diseases, 9th Revision diagnosis and procedures codes to identify adult patients who underwent thyroid and parathyroid surgery and subsequently developed neck hematoma. Patient and hospital characteristics were collected along with surgeon volume to predict patient outcomes. Surgical procedures were stratified into three groups according to surgeon volume: low (less than 10 operations), intermediate (10 to 99), and high (100 or more). We identified 147,344 thyroid and parathyroid surgery performed between 2000 and 2009 nationwide. Overall incidence of postoperative neck hematoma was 1.5 per cent (n = 2210). This was 2.1, 1.4, and 0.9 per cent among procedures performed by low-volume, intermediate-volume, and high-volume surgeons, respectively. After adjusting for other confounders, compared with procedures performed by low-volume surgeons, those performed by intermediate- (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6 to 0.8; P < 0.01) and high-volume surgeons (OR, 0.5; 95% CI, 0.4 to 0.6; P < 0.01) were less to likely to develop neck hematoma. Surgeon experience is significantly associated with the development of neck hematoma after thyroid and parathyroid surgery.
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Affiliation(s)
- Ahmed Dehal
- Arrowhead Regional Medical Center, Colton, California; the
| | - Ali Abbas
- University of Florida, Gainesville, Florida; and
| | | | - Farabi Hussain
- Arrowhead Regional Medical Center, Colton, California; the
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Woods RSR, Woods JFC, Duignan ES, Timon C. Systematic review and meta-analysis of wound drains after thyroid surgery. Br J Surg 2014; 101:446-56. [PMID: 24633830 DOI: 10.1002/bjs.9448] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed. RESULTS Twenty-five RCTs were included in the meta-analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound-assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. -0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units). CONCLUSION The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
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Affiliation(s)
- R S R Woods
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Soh S, Park WK, Kang SW, Lee BR, Lee JR. Sex differences in remifentanil requirements for preventing cough during anesthetic emergence. Yonsei Med J 2014; 55:807-14. [PMID: 24719152 PMCID: PMC3990090 DOI: 10.3349/ymj.2014.55.3.807] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/25/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Target-controlled infusion (TCI) of remifentanil can suppress coughing during emergence from general anesthesia; nevertheless, previous studies under different clinical conditions recommend significantly different effective effect-site concentrations (effective Ce) of remifentanil for 50% of patients (EC₅₀). The differences among these studies include type of surgery and patient sex. In recent years, study of sex differences in regards to anesthetic pharmacology has drawn greater interest. Accordingly, we attempted to determine the effective Ce of remifentanil for preventing cough for each sex under the same clinical conditions. MATERIALS AND METHODS Twenty female and 25 male ASA physical status I-II grade patients between the ages of 20 and 46 years who were undergoing thyroidectomy were enrolled in this study. The effective Ce of remifentanil for preventing cough was determined for each sex using the isotonic regression method with a bootstrapping approach, following Dixon's up-and-down method. RESULTS Isotonic regression with a bootstrapping approach revealed that the estimated EC₅₀ of remifentanil for preventing coughing during emergence was significantly lower in females {1.30 ng/mL [83% confidence interval (CI), 1.20-1.47 ng/mL]} than in males [2.57 ng/mL (83% CI, 2.45-2.70 ng/mL)]. Mean EC₅₀ in females was also significantly lower than in males (1.23±0.21 ng/mL vs. 2.43±0.21 ng/mL, p<0.001). Mean arterial pressure, heart rate, and respiratory rate over time were not significantly different between the sexes. CONCLUSION When using remifentanil TCI for cough prevention during anesthetic emergence, patient sex should be a considered for appropriate dosing.
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Affiliation(s)
- Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Ra Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Rim Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014; 156:399-404. [PMID: 24947642 DOI: 10.1016/j.surg.2014.03.015] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hematoma after thyroidectomy is a potentially lethal complication. We sought to evaluate risk factors for hematoma formation using the Nationwide Inpatient Sample. We hypothesized that certain risk factors could be identified and that this information would be useful to surgeons. METHODS The Nationwide Inpatient Sample database was queried for patients who underwent thyroidectomy from 1998 to 2010. Bivariate analysis was used to compare patients with and without hematoma. Logistic regression was performed to identify important predictors of hematoma. RESULTS There were 150,012 patients. The rate of hematoma was 1.25%. Female sex and high-volume hospitals were important for decreased hematoma risk (odds ratio 0.61[0.54-0.69] and 0.71 [0.56-0.83], respectively). Black race, age >45 years, inflammatory thyroid disease, partial thyroidectomy, chronic kidney disease, and bleeding disorders increased the risk of hematoma (odds ratio 1.37, 1.44, 1.59, 1.69, 1.8, 3.38; respectively). Overall mortality was 0.32% for the entire group and 1.34% in patients with postoperative hematoma (P < .001). Patients with hematoma after thyroidectomy were 2.94 [1.76-4.9] times more likely to die than those without hematoma. CONCLUSION We identified risk factors associated with postoperative hematoma after thyroidectomy. Such information should be useful for surgeons for predicting patients at risk for this potentially lethal complication.
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