Risk Factors for Cervical Hematoma After Thyroid Surgery at a Portuguese Hospital: A Retrospective Study

Cervical hematoma post thyroid surgery is an uncommon but potentially life-threatening postoperative complication. Moreover, despite its low incidence, this complication has been a barrier to outpatient surgical care. Assessing postoperative complication rates and their risk factors can improve the safety and cost-effectiveness of these procedures, which is especially useful in promoting outpatient surgical care.

This retrospective study included 198 patients who underwent thyroid surgery in the district of Viseu (Portugal) between January 2020 and December 2021. The sample was analyzed to determine the incidence of cervical hematoma post thyroid surgery and to identify possible medical and modifiable anesthetic risk factors related to hematoma. To determine the risk factors, the sample was divided into two groups: Group 1 included patients without postoperative cervical hematoma and Group 2 included patients with postoperative cervical hematoma Result: The incidence of postoperative cervical hematoma was 6.0%, slightly higher than previously reported in the literature. Univariate analysis identified two factors associated with post-surgical cervical hematoma in our sample: a medical history of obstructive lung disease and intraoperative administration of ketorolac. Several studies have reliably associated a history of chronic obstructive pulmonary disease (COPD) with airway reactivity, especially during an anesthetic emergency. The use of non-steroidal analgesics is widespread in intraoperative practice, and the literature consistently supports the safety of their administration in endocrine cervical surgical procedures. Our study revealed controversies related to this topic, and in our opinion, patients who received intraoperative ketorolac in our cohort tended to follow an opioid-free analgesia regimen, leading to more pain and discomfort post surgery. Discomfort and pain in the immediate postoperative period have been identified as potential risk factors for cervical hematoma.

Patients with obstructive lung disease ​​​​​​should be carefully monitored after thyroid surgery and may not be suitable for an ambulatory thyroidectomy. The risk of postoperative bleeding and the benefits of intraoperative ketorolac administration should be balanced, particularly for high-risk patients like those with obstructive pulmonary disease. The establishment of standardized anesthetic protocols for thyroid surgery can enhance the safety and cost-effectiveness of procedures, helping to define feasible preoperative criteria for patient selection in outpatient care.