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Published on: July 28, 2026
Predictors of Post-Thyroidectomy Cervical Hematoma: Does Operative Start Time Matter? A Retrospective Single-Center
Ufuk Karabacak1, Hamdi Burak Piyade1, Murat Derebey1
1Department of General Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun 55200, Türkiye.
Medicina (Kaunas, Lithuania)
|July 28, 2026
Summary
Thyroidectomies starting late in the day (after 3 PM) are linked to a higher risk of post-thyroidectomy cervical hematoma (PCH). This suggests scheduling and operating room workflow may impact patient safety outcomes.
Area of Science:
- Surgical Complications
- Patient Safety
- Health Services Research
Background:
- Post-thyroidectomy cervical hematoma (PCH) is a rare but severe complication requiring potential reoperation and airway management.
- Existing research on PCH risk factors primarily focuses on patient, disease, and surgical variables, with limited understanding of operative scheduling's impact.
Purpose of the Study:
- To investigate the association between operative start time, operating room case order, and surgeon-specific daily case volume with the occurrence of PCH.
- To identify potential scheduling-related risk factors for post-thyroidectomy cervical hematoma.
Main Methods:
- Retrospective review of adult patients undergoing thyroidectomy between January 2005 and March 2026.
- Case group comprised patients requiring reoperation for PCH; control group included matched patients without PCH from the same surgical team/week.
- Statistical analysis included univariable and multivariable logistic regression to identify independent risk factors.
Main Results:
- The study included 35 PCH cases and 143 controls.
- Multivariable analysis identified hyperthyroidism (OR 4.80) and operative start time ≥15:00 (OR 13.11) as independent risk factors for PCH.
- Thyroidectomies initiated at or after 15:00 were significantly associated with an increased risk of PCH.
Conclusions:
- Late operative start times (≥15:00) for thyroidectomy may increase the risk of PCH, potentially due to system-level factors.
- Factors such as operating room workflow, team continuity, anesthesia handover, and postoperative monitoring may contribute to this increased risk.
- Further validation in larger, multicenter studies is warranted to confirm these findings.
