Predictors of Post-Thyroidectomy Cervical Hematoma: Does Operative Start Time Matter? A Retrospective Single-Center...

Background/Objectives: Post-thyroidectomy cervical hematoma (PCH) is a rare but life-threatening complication that may require emergency airway management and reoperation. Although many patient-, disease-, and surgery-related risk factors have been investigated, the effect of operative scheduling-related variables on PCH remains unclear. This study aimed to evaluate the association between operative start time, operating room case order, surgeon-specific daily case volume, and PCH. Materials and Methods: Adult patients who underwent thyroidectomy at our clinic between January 2005 and March 2026 were retrospectively reviewed. Patients requiring reoperation for PCH constituted the case group. All patients operated on by the same surgical team within the same week as each PCH case and who did not develop PCH were included as controls. This approach was used to reduce heterogeneity related to the long study period, institutional workflow, and team rotation in a tertiary teaching hospital. Results: A total of 35 patients with PCH and 143 controls were included in the analysis. The study cohort included 178 adult patients with a mean age of 48.4 ± 14.0 years; 48 patients (27.0%) were male, and 31 patients (17.4%) had two or more comorbidities. Among patients who developed PCH, 20 (57.1%) underwent reoperation within the first 12 h, 10 (28.6%) between 12 and 24 h, and 5 (14.3%) after 24 h. In univariable analysis, older age, male sex, hyperthyroidism, lymphocytic thyroiditis, intrathoracic extension, absence of preoperative malignancy diagnosis/suspicion, and operative start time ≥15:00 were associated with PCH. In multivariable analysis, only hyperthyroidism (OR 4.80; 95% CI 1.65-13.92; p = 0.004) and operative start time ≥15:00 (OR 13.11; 95% CI 4.55-37.81; p < 0.001) were identified as independent risk factors. Conclusions: Thyroidectomies starting at or after 15:00, and likely extending into after-hours periods, may carry an increased risk of PCH, potentially reflecting system-level factors such as operating room workflow, non-surgeon perioperative team continuity, anesthesia handover, and postoperative monitoring conditions. These findings should be interpreted in light of the retrospective single-center design, tertiary teaching-hospital setting, limited number of PCH events, and possible residual confounding. Further validation in larger multicenter studies is warranted.