Frontiers in Surgery (Oct 2023)

Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study)

  • Gian Luigi Canu,
  • Fabio Medas,
  • Federico Cappellacci,
  • Leonardo Rossi,
  • Benard Gjeloshi,
  • Luca Sessa,
  • Luca Sessa,
  • Francesco Pennestrì,
  • Francesco Pennestrì,
  • Reza Djafarrian,
  • Maria Mavromati,
  • George Kotsovolis,
  • George Kotsovolis,
  • Ioannis Pliakos,
  • Ioannis Pliakos,
  • Giacomo Di Filippo,
  • Giovanni Lazzari,
  • Carla Vaccaro,
  • Martina Izzo,
  • Francesco Boi,
  • Paolo Brazzarola,
  • Francesco Feroci,
  • Francesco Feroci,
  • Marco Stefano Demarchi,
  • Theodossios Papavramidis,
  • Theodossios Papavramidis,
  • Gabriele Materazzi,
  • Marco Raffaelli,
  • Marco Raffaelli,
  • Pietro Giorgio Calò,
  • REDHOT Study Collaborative Group,
  • Giacomo Anedda,
  • Cristina Soddu,
  • Francesco Casti,
  • Miriam Biancu,
  • Silvia Puddu,
  • Selina Russo,
  • Andrea De Palma,
  • Francesco Pignatelli,
  • Elisa Loguercio,
  • Livia Palmieri,
  • Giulia Salvi,
  • Priscilla Francesca Procopio,
  • Eleonora Morelli,
  • Dorin Serbusca,
  • Alessio Biagio Filippo Giordano,
  • Giulia Fiorenza,
  • Sophie Leboulleux,
  • Nathalie Massé

DOI
https://doi.org/10.3389/fsurg.2023.1278696
Journal volume & issue
Vol. 10

Abstract

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BackgroundPostoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.MethodsPatients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed.ResultsEight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P < 0.001), older age (P < 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P < 0.001), drain placement (P = 0.007), and shorter operative times (P < 0.001) were found to be independent risk factors for cervical haematoma.ConclusionsBased on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery.

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