Reexploration for symptomatic hematomas after cervical exploration

Hematomas requiring reoperation affect 1% of patients undergoing cervical exploration. This complication has implications for the trend toward outpatient procedures.

Retrospective review of 13,817 patients undergoing thyroidectomy and parathyroidectomy at this institution (1976 to 2000) identified 42 patients with hematomas requiring reoperation. Case controls (n = 42) were matched for age, gender, and type and year of operation. Perioperative risk factors and outcome were compared.

Study and control groups were composed of 18 men and 24 women (mean age, 62 years) undergoing thyroidectomy (n = 21) or parathyroidectomy (n = 21). Comparison of perioperative risk factors yielded no significant difference between groups. Symptoms included respiratory distress in 21 patients, pain/pressure in 11, dysphagia in 8, and drainage in 6. Mean time to symptom onset was 17 hours (range, 10 minutes to 5 days). Eighteen hematomas presented within 6 hours postoperatively, 16 between 7 and 24 hours, and eight beyond 24 hours. The bleeding source was arterial in 11 patients, venous in 8, thyroid/soft tissue in 13, and indeterminate in 10. Mean hospital stay was longer in the study group (7.2 vs 3.6 days, P = .004). The number of patients with complications was higher in the study group (17 vs 7, P = .03). No single complication reached significance: hypocalcemia (8 vs 3, P = .12), wound infection (3 vs 0, P = .87), and others (10 vs 5, P = .21).

(1) No factor foreshadowed this complication. (2) The definition of a high-risk population remains obscure. (3) Sixty percent presented beyond 6 hours postoperatively. (4) Reexploration increased morbidity and lengthened hospital stay.