Cervical haematoma after thyroid surgery: management and prevention

The aim of this study was to evaluate the incidence and circumstances of cervical haematomas complicating thyroid surgery. The second objective was to study the effects of modifying our unit's practice on this complication. The study involved a retrospective chart review of 504 consecutive thyroid operations performed by one surgeon from 1994 to 2005. The operations were carried out in the Professorial units of Otolaryngology Head and Neck Surgery in two teaching hospitals in Dublin, Ireland. Indications for surgery included tumour in 338(67%), airway compromise in 60(12%) and thyroid over-activity in 106 (21%). 116(230/c) patients were male and 388(77%) were females. Ages ranged from 16 to 78 years and the mean age was 34.6 years. 292 (58%) patients had two vacuum drains inserted (eighth inch). 126(25%) had a single drain and 86(17%) patients had no drains used. 44 patients were operated through a small incision (4cms.) with the help of rigid endoscopes (Minimally invasive video assisted thyroid surgery (MIVAT)). During the study period seven patients (1.4%) out of 504 were re-explored due to the development of haematomas. None of the patients needed a tracheostomy. Cervical haematomas developed in 1.4 %/o thyroid surgeries which is consistent with current literature. Predisposing factors like coagulation modifying medications are common and avoidable. Most haematomas develop within 6 hours of surgery. Drains and size of incision do not appear to change the rate of this complication. Strict protocols and training of the care teams is vital.