Predictors and Consequences of Hematoma After Thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Program Database Analysis.

Autor: Mahoney RC; Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii., Vossler JD; Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii., Woodruff SL; Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii., Murayama KM; Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii. Electronic address: kenricm@hawaii.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2021 Apr; Vol. 260, pp. 481-487. Date of Electronic Publication: 2020 Dec 16.
DOI: 10.1016/j.jss.2020.11.081
Abstrakt: Background: Hematoma after thyroid surgery is a serious complication. The purpose of this study was to determine the predictors and consequences of hematoma after thyroid surgery.
Materials and Methods: A retrospective analysis of 11,552 open thyroidectomies was conducted using the American College of Surgeons National Surgical Quality Improvement Program 2016-2017 main and thyroidectomy-targeted procedure databases. Predictors of hematoma and the effect of hematoma on outcomes were analyzed by multivariate logistic regression, resulting in risk-adjusted odds ratios of hematoma and morbidity/mortality, respectively. Statistical analysis was performed using R version 3.5.1.
Results: We found that male gender (odds ratio 1.71, 95% confidence interval 1.25-2.32; P value 0.0007), Black race (1.89, 1.27-2.77; 0.0014), other race (1.76, 1.23-2.50; 0.0017), hypertension (1.68, 1.20-2.35; 0.0026), diabetes (1.45, 1.00-2.06; 0.0460), and bleeding disorders (3.63, 1.61-7.28; 0.0007) were independent risk factors for postoperative hematoma. The use of an energy device for hemostasis (0.63, 0.46-0.87; 0.0041) was independently associated with decreased hematoma rate. Postoperative hematoma was an independent risk factor for overall morbidity (3.04, 2.21-4.15; <0.0001), hypocalcemia (1.73, 1.08-2.66, 0.0162), recurrent laryngeal nerve injury (2.42, 1.57-3.60, <0.0001), pulmonary morbidity (18.91, 10.13-34.16, <0.0001), wound morbidity (10.61, 5.54-19.02, <0.0001), readmission (5.23, 3.34-7.92, <0.0001), return to operating room (90.73, 62.62-131.97; <0.0001), and length of stay greater than the median (5.10, 3.62-7.15, <0.0001).
Conclusions: Identified by this study are the predictors of postthyroidectomy hematoma and the consequences thereof. Notably, the use of energy devices for hemostasis was shown to be protective of postoperative hematoma. The results of this study may guide pre- and intra-operative decision-making for thyroidectomy to reduce rates of postoperative hematoma.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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