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Life-threatening neck hematoma complicating thyroid and parathyroid surgery
Michael A Rosenbaum1, Manjunath Haridas, Christopher R McHenry
1Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH 44109, USA.
American Journal of Surgery
|February 5, 2008
Summary
Shortening observation after thyroid and parathyroid surgery is possible. Unilateral procedures can be outpatient, while bilateral requires 23-hour observation to ensure patient safety.
Area of Science:
- Endocrine Surgery
- Surgical Oncology
- Head and Neck Surgery
Background:
- Post-thyroidectomy and parathyroidectomy observation periods have been reduced.
- The primary challenge is to shorten observation without compromising patient safety.
Purpose of the Study:
- To evaluate the frequency of life-threatening hematoma and hospital readmissions.
- To determine the impact of these events on postoperative observation duration.
Main Methods:
- Retrospective review of 1,050 patients undergoing thyroidectomy and/or parathyroidectomy (July 1990 - March 2007).
- Analysis of hematoma occurrence, timing, and readmission causes (hypocalcemia, hematoma, infection, respiratory distress).
Main Results:
- Life-threatening hematoma occurred in 0.6% of patients (6/1050), predominantly after bilateral thyroidectomy.
- Hematoma onset varied from 10 minutes to 7 days postoperatively.
- Readmissions (12 patients) were for hypocalcemia, hematoma, infection, or respiratory distress, averaging 5 days post-discharge.
Conclusions:
- Unilateral thyroidectomy and parathyroidectomy, without bleeding risk factors, can be safely performed as ambulatory procedures.
- Recommended observation: 4 hours for unilateral and 23 hours for bilateral thyroidectomy to maximize safety.
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