24-Hour Observation After Thyroid and Parathyroid Surgery for Central Neck Hematomas: Is This Really Necessary?

Central neck hematomas (CNHs) after thyroidectomy and parathyroidectomy are rare but potentially life-threatening complications. Many surgeons are reluctant to perform these operations in an ambulatory facility with same-day discharge due to this fear, and most admit patients for 24 h or more for observation. As our institution frequently deals with inpatient bed shortage, surgical cases are limited. Therefore, we reviewed the incidence and timing of CNH after thyroid and parathyroid surgery at our institution to further elucidate safety of same-day discharge given bed shortages and the growing need for outpatient surgeries.

Prospective, single-institution databases of parathyroid operations and thyroid operations with a combined total of 1614 patients were reviewed for details related to timing of CNH, patient characteristics, comorbidities, and risk factors. Patients were included if they had surgery between 2016 and 2022.

The rate of CNH from 2016 to 2022 was 0.4% (7/1614 patients). Hematomas were more common after thyroidectomy (0.7%) compared to parathyroidectomy (0.1%). Of all the patients with hematomas, 28.6% occurred in the postanesthesia care unit (PACU), and 57% occurred more than 48 h after surgery. Importantly, only one CNH occurred within 24 h of discharge from the PACU. Patients with delayed hematomas required hematoma evacuation on postoperative days 2, 3, and 6. There were no hematoma related morbidities or mortalities. All patients with hematomas had risk factors for postoperative hematoma including anticoagulation/antiplatelet therapy (57%) and Graves disease (43%).

In this series, all but one CNH after thyroid and parathyroid surgery occurred either immediately in the PACU or after 24 h. All patients were effectively managed with operative hematoma evacuation without mortality. While focused in a hospital setting with significant bed shortage, we see that thyroid and parathyroid surgery can be safely performed in an ambulatory setting without the need for 24-h admissions for observation.