1
|
Sarmast Shoushtari MH, Sherafatmand S, Rostami A, Mohammadi A, Shayesteh B, Farhadi F. Evaluation of Hematoma Formation after Thyroidectomy Surgery and Its Related Factors. World J Plast Surg 2024; 13:37-42. [PMID: 38742026 PMCID: PMC11088728 DOI: 10.61186/wjps.13.1.37] [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: 12/10/2023] [Accepted: 03/16/2024] [Indexed: 05/16/2024] Open
Abstract
Background In the last decade, the number of patients undergoing thyroidectomy has increased. Compared to other methods, thyroidectomy is a relatively safe method for treating various types of thyroid diseases. However, the blood flow rate in the thyroid gland is high, and hematoma after thyroidectomy is one of its complications. We aimed to evaluate hematoma after thyroidectomy and its related factors. Methods In this retrospective study, 2320 patients over 20 years of age who underwent thyroidectomy in Imam Khomeini, Arvand, and Mehr Ahvaz hospitals, Khuzestan Province, southern Iran between 2011 and 2022 were enrolled. Data were analyzed using SPSS software, version 22. Results 70.7% of the patients were in the age range of 20-50 years. Twenty-five (1.1%) of patients developed a hematoma after thyroidectomy. Males are more likely to hematoma after surgery (P=0.01). Hematoma was significantly higher in patients with a history of hypertension (P=0.001). Moreover, a significant association was found between male gender, and age over 50 years with the risk of hematoma (P<0.05). The incidence of hematoma had a statistically remarkable correlation with follicular thyroid cancer pathology (P=0.001). Other pathology diagnoses were not significantly related to hematoma formation after thyroidectomy. Conclusions Hematoma after thyroidectomy surgery is a rare, but dangerous and life-threatening complication. It is important to identify risk factors for hematoma formation.
Collapse
Affiliation(s)
- Mohammad Hossein Sarmast Shoushtari
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental and Petroleum Pollutants Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shaghayegh Sherafatmand
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ayat Rostami
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Mohammadi
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behrouz Shayesteh
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farbod Farhadi
- Department of General Surgery, School of Medicine, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
2
|
Ezzy M, Alameer E. Predictors and Preventive Strategies of Bleeding After Thyroid Surgery. Cureus 2023; 15:e47575. [PMID: 38021981 PMCID: PMC10666654 DOI: 10.7759/cureus.47575] [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: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
Collapse
Affiliation(s)
- Mohsen Ezzy
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Ehab Alameer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| |
Collapse
|
3
|
Chui JN, Papachristos AJ, Mechera R, Sidhu SB, Sywak MS, Lee JC, Gundara J, Lai C, Glover AR. Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality. Br J Surg 2022; 109:1164-1171. [PMID: 35927948 PMCID: PMC10364700 DOI: 10.1093/bjs/znac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) were used here to understand and elucidate potential systems issues that may contribute to preventable deaths. METHODS ANZASM data relating to 30-day mortality after thyroidectomy, parathyroidectomy, and adrenalectomy from 2009 to 2020 were reviewed. Mortality rates were calculated using billing data. Thematic analysis of independent assessor reports was conducted to produce a coding framework. RESULTS A total of 67 deaths were reported, with an estimated mortality rate of 0.03-0.07 per cent (38 for thyroidectomy (0.03-0.06 per cent), 16 for parathyroidectomy (0.03-0.06 per cent), 13 for adrenalectomy (0.15-0.33 per cent)). Twenty-seven deaths (40 per cent) were precipitated by clinically significant adverse events, and 18 (27 per cent) were judged to be preventable by independent ANZASM assessors. Recurrent themes included inadequate preoperative assessment, lack of anticipation of intraoperative pitfalls, and failure to recognize and effectively address postoperative complications. Several novel themes were reiterated, such as occult ischaemic heart disease associated with death after parathyroid surgery, unexpected intraoperative difficulties from adrenal metastasis, and complications due to anticoagulation therapy after thyroid surgery. CONCLUSION This study represents a large-scale national report of deaths after endocrine surgery and provides insights into these rare events. Although the overall mortality rate is low, 27 per cent of deaths involved systems issues that were preventable following independent peer review.
Collapse
Affiliation(s)
| | | | - Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James C Lee
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Justin Gundara
- Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Logan, Australia
| | - Christine Lai
- Division of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anthony R Glover
- Correspondence to: Anthony R. Glover, Royal North Shore Hospital Level 3, Endocrine and Oncology, ASB, St Leonards, New South Wales, 2065, Australia (e-mail: )
| |
Collapse
|
4
|
von Ahnen T, Schardey J, von Ahnen M, Busch P, Schardey E, Ezzy MA, Schopf S, Wirth U. Neck Circumference Measurement for Surveillance and Early Detection of Hemorrhage After Thyroidectomy: A Diagnostic Accuracy Study. JAMA Otolaryngol Head Neck Surg 2022; 148:646-653. [PMID: 35679063 PMCID: PMC9185515 DOI: 10.1001/jamaoto.2022.1180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection. Objective To evaluate the diagnostic accuracy of neck circumference measurement for early detection of postoperative hemorrhage after thyroidectomy. Design, Setting, and Participants This diagnostic accuracy study at an academic teaching hospital used a prospective cohort of patients undergoing thyroid surgery from November 1, 2015, to January 31, 2018 (group 1), and a retrospective cohort of patients undergoing the same surgery from January 1, 2020, to September 30, 2021 (group 2). We performed repeated perioperative neck circumference measurements to evaluate the association of increased neck circumference with postthyroidectomy hemorrhage among patients at risk for hemorrhage. Main Outcomes and Measures The primary end point was the diagnostic value of neck circumference measurement for detection of postthyroidectomy hemorrhage. Additionally, data on demographic information and risk factors for postthyroidectomy hemorrhage were examined. Data analyses were performed from November 1, 2021, to January 5, 2022. Results The prospective cohort (group 1) comprised 60 patients (45 [75%] women) with a mean (SD) age of 52.2 (13.5) years; those who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 57.4 (9.0) years. The retrospective cohort (group 2) comprised 353 patients (258 [73%] women) with a mean (SD) age of 55.3 (14.1) years; patients who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 62.2 (10.0) years. In group 1, postoperative neck circumference increased by a median (range) of 5.0 (4.0 to 7.0) cm in patients with hemorrhage, and only 1.0 (-2.5 to 4.0) cm in patients with no postoperative bleeding (difference in the medians, 4.0 cm [95% CI, 3.0 to 5.5 cm]; effect size, 3.74 [95% CI, 2.6 to 4.9]). Defining a 7% or greater increase in neck circumference as the cutoff value for detecting postthyroidectomy hemorrhage showed a diagnostic sensitivity and specificity of 1.0 (95% CI, 0.48 to 1.0) and 0.86 (95% CI, 0.71 to 0.92), respectively. The retrospective validation also showed a difference in median (range) increase of postoperative neck circumference between patients with hemorrhage and those without-3.0 (0 to 6.0) cm vs 0.0 (-6.0 to 5.0) cm (difference in medians, 3.8 cm [95% CI, 3.0 to 4.9]; effect size, 1.63 [95% CI, 0.96 to 2.3]). Considering 12 false-positive and 332 correct-negative results, the diagnostic tool showed a sensitivity of 0.89 (95% CI, 0.51 to 0.99) and a specificity of 0.97 (95% CI, 0.94 to 0.98). Conclusions and Relevance The findings of this diagnostic accuracy study suggest that neck circumference measurement is a feasible and easy-to-use diagnostic tool for routine clinical care to detect postthyroidectomy hemorrhage. A 7% or greater increase over the postoperative baseline neck circumference seems to be a reliable threshold for detecting postthyroidectomy hemorrhage. Neck circumference measurement should be used in combination with surveillance of clinical signs and symptoms.
Collapse
Affiliation(s)
- Thomas von Ahnen
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Josefine Schardey
- Institute for Surgical Research Oberbayern, Hausham, Germany,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin von Ahnen
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Peter Busch
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Emily Schardey
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Institute for Surgical Research Oberbayern, Hausham, Germany
| | - Mohsen Ali Ezzy
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Department of General and Minimal Invasive Surgery, Nordwest Hospital, Frankfurt, Germany
| | - Stefan Schopf
- Department for General, Visceral, Endocrine, and Vascular Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany,Institute for Surgical Research Oberbayern, Hausham, Germany,Surgical Department, RoMed Klink Bad Aibling, Bad Aibling, Germany
| | - Ulrich Wirth
- Institute for Surgical Research Oberbayern, Hausham, Germany,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
5
|
Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2021; 16:482-490. [PMID: 34691299 PMCID: PMC8512510 DOI: 10.5114/wiitm.2021.105722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Aim This systematic review and meta-analysis evaluates surgical outcome and safety results of conventional (OT) versus endoscopic transaxillary gasless thyroidectomies (ET). Material and methods A systematic literature search was performed. The weighted mean differences or the odd ratios with corresponding 95% CIs were examined for surgical outcomes and complications. The results were analysed using fixed- or random-effects models. The heterogeneity was checked by the Cochran Q test and the extent of inconsistency was evaluated by the I2 statistic. Results Ten studies and 1597 patients were included. All studies found that ET required longer operative time. Postoperative pain was significantly lower after ET on day 1 and day 7. No statistical difference was found in complication rates. Conclusions ET has disadvantages such as longer surgery time, but it is a feasible and safe procedure with lower postoperative pain and comparable complication rates to OT. However, good quality prospective randomised studies are necessary to draw firmer conclusions.
Collapse
|
6
|
Pino A, Frattini F, Sun H, Zhang D, Wu CW, Kim HY, Dionigi G. Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery. Surg Technol Int 2021; 38:57-61. [PMID: 34043230 DOI: 10.52198/21.sti.38.so1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). METHODS Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves' disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). RESULTS Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. CONCLUSION This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.
Collapse
Affiliation(s)
- Antonella Pino
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Francesco Frattini
- Division of General Surgery, Ospedale di Circolo e Fondazione Macchi di Varese - ASST dei Sette Laghi, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China
| | - Che Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| |
Collapse
|