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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

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Published on: May 12, 2023

Is DVT prophylaxis necessary for thyroidectomy and parathyroidectomy?

Madhuchhanda Roy¹, Victoria Rajamanickam, Herbert Chen

¹Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, WI, USA.

|December 8, 2010

Summary

Deep vein thrombosis (DVT) prophylaxis is often recommended after surgery, but for thyroidectomy and parathyroidectomy patients, the risk of bleeding complications outweighs the low risk of DVT/PE. Prophylaxis should be individualized.

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Area of Science:

Surgical outcomes research
Thromboprophylaxis
Endocrine surgery

Background:

Current guidelines recommend pharmacologic deep vein thrombosis (DVT) prophylaxis for major surgeries to prevent DVT and pulmonary embolism (PE).
Perioperative DVT prophylaxis may increase bleeding risks.
The risk-benefit ratio of DVT prophylaxis in thyroidectomy and parathyroidectomy patients requires evaluation.

Purpose of the Study:

To assess the risk-benefit ratio of DVT prophylaxis in patients undergoing thyroidectomy and parathyroidectomy.
To compare the incidence of DVT/PE complications with bleeding risks in this patient group.

Main Methods:

A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database from 2005 to 2007.
Comparison of DVT/PE incidence in 16,022 thyroidectomy/parathyroidectomy patients versus a larger cohort of 347,862 general surgical patients.
Identification of DVT/PE risk factors and development of a surrogate variable for postoperative bleeding risk.

Main Results:

The incidence of DVT/PE complications was significantly lower in thyroidectomy/parathyroidectomy patients (0.16%) compared to the overall surgical cohort (0.96%) (P < .001).
The estimated risk of bleeding requiring reoperation was 1.58%.
The risk of bleeding complications was approximately 10-fold greater than the risk of DVT/PE in these patients (P < .001).

Conclusions:

Thyroidectomy and parathyroidectomy patients exhibit a low incidence of DVT/PE complications.
These patients face a substantially higher risk of bleeding complications compared to DVT/PE.
DVT prophylaxis in these specific surgical procedures should be considered on a case-by-case basis, reserved for select high-risk individuals at the surgeon's discretion.