A novel method for the management of post-thyroidectomy or parathyroidectomy hematoma: A single-institution experience after over 4,000 central neck operations

Jennifer L. Dixon, Samuel K. Snyder, Terry C. Lairmore, Daniel Jupiter, Cara Govednik, John C. Hendricks

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Cervical hematoma is a rare but serious complication of thyroid and parathyroid surgery that has historically required inpatient monitoring. With improved surgical technique and experience, operations are being performed increasingly as outpatient procedures. Therefore, a safe and systematic approach to cervical exploration of a postoperative hematoma needs to be defined. Methods: From 1996 to 2013, a retrospective review was performed of 4,140 thyroid and parathyroid operations. Surgical outcomes data were recorded, specifically including the occurrence of a cervical hematoma, time interval to presentation, and methods of management. Results: A total of 18 patients (0.43 %) developed a postoperative cervical hematoma that required surgical intervention. The occurrence of hematoma was 0.66 % (n = 11) for bilateral thyroid procedures, 0.21 % (n = 3) for unilateral thyroid procedures, and 0.13 % (n = 1) for parathyroid procedures. There were 3 (1.69 %) patients who had combined unilateral thyroid and parathyroid procedures and developed hematomas. Emergent bedside decompression was required for only two patients, both of whom suffered respiratory arrest in the postoperative anesthesia recovery unit. The remaining 16 patients were explored in the operating room, utilizing initial local anesthesia in the semi-upright position in 11 patients (69 %). Conclusions: From our experience, hematomas that caused significant airway compromise leading to respiratory arrest occurred in the postoperative anesthesia recovery room, and hematoma presentation after this time did not require emergent bedside decompression. Hematoma, when it occurs, can otherwise be managed safely in the operating room after inpatient or outpatient procedures using initial local anesthesia with the patient in the semi-upright position for hematoma evacuation.

Original languageEnglish (US)
Pages (from-to)1262-1267
Number of pages6
JournalWorld Journal of Surgery
Volume38
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

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Parathyroidectomy
Thyroidectomy
Hematoma
Neck
Thyroid Gland
Local Anesthesia
Operating Rooms
Decompression
Inpatients
Outpatients
Anesthesia
Recovery Room

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

A novel method for the management of post-thyroidectomy or parathyroidectomy hematoma : A single-institution experience after over 4,000 central neck operations. / Dixon, Jennifer L.; Snyder, Samuel K.; Lairmore, Terry C.; Jupiter, Daniel; Govednik, Cara; Hendricks, John C.

In: World Journal of Surgery, Vol. 38, No. 6, 2014, p. 1262-1267.

Research output: Contribution to journalArticle

Dixon, Jennifer L. ; Snyder, Samuel K. ; Lairmore, Terry C. ; Jupiter, Daniel ; Govednik, Cara ; Hendricks, John C. / A novel method for the management of post-thyroidectomy or parathyroidectomy hematoma : A single-institution experience after over 4,000 central neck operations. In: World Journal of Surgery. 2014 ; Vol. 38, No. 6. pp. 1262-1267.
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abstract = "Background: Cervical hematoma is a rare but serious complication of thyroid and parathyroid surgery that has historically required inpatient monitoring. With improved surgical technique and experience, operations are being performed increasingly as outpatient procedures. Therefore, a safe and systematic approach to cervical exploration of a postoperative hematoma needs to be defined. Methods: From 1996 to 2013, a retrospective review was performed of 4,140 thyroid and parathyroid operations. Surgical outcomes data were recorded, specifically including the occurrence of a cervical hematoma, time interval to presentation, and methods of management. Results: A total of 18 patients (0.43 {\%}) developed a postoperative cervical hematoma that required surgical intervention. The occurrence of hematoma was 0.66 {\%} (n = 11) for bilateral thyroid procedures, 0.21 {\%} (n = 3) for unilateral thyroid procedures, and 0.13 {\%} (n = 1) for parathyroid procedures. There were 3 (1.69 {\%}) patients who had combined unilateral thyroid and parathyroid procedures and developed hematomas. Emergent bedside decompression was required for only two patients, both of whom suffered respiratory arrest in the postoperative anesthesia recovery unit. The remaining 16 patients were explored in the operating room, utilizing initial local anesthesia in the semi-upright position in 11 patients (69 {\%}). Conclusions: From our experience, hematomas that caused significant airway compromise leading to respiratory arrest occurred in the postoperative anesthesia recovery room, and hematoma presentation after this time did not require emergent bedside decompression. Hematoma, when it occurs, can otherwise be managed safely in the operating room after inpatient or outpatient procedures using initial local anesthesia with the patient in the semi-upright position for hematoma evacuation.",
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