Evacuation of postoperative hematomas after thyroid and parathyroid surgery: An analysis of the CESQIP Database

Abstract

A feared complication after thyroid and parathyroid operations is postoperative hematoma that threatens the airway. The aim of this study was to identify factors associated with postoperative hematoma. Patients undergoing thyroidectomy or parathyroidectomy were evaluated for postoperative hematoma requiring operative intervention using the database of the Collaborative Endocrine Surgery Quality Improvement Program. Associations between perioperative factors and postoperative hematoma were evaluated with bivariate methodologies and multivariable logistic regression. Among 19,356 patients, 60.4% underwent thyroidectomy ± lymph node dissection, 34.9% parathyroidectomy, and 4.7% concurrent thyroidectomy/parathyroidectomy. Postoperative hematoma occurred in 0.6% overall: 0.7% of thyroidectomies, 0.3% of parathyroidectomies, and 1.3% of combined thyroid/parathyroid operations (P < .001). The incidence of postoperative hematoma was greater among men (P < .001) and after greater operative times (P < .001) but was not influenced by body mass index, prior neck surgery, or reoperations. Multivariable logistic regression determined that operative complexity, operation >1 hour, male sex, and age were independently associated with postoperative hematoma. Postoperative hematoma were associated with greater rates of other complications as well. Large databases such as Collaborative Endocrine Surgery Quality Improvement Program are useful to evaluate rare complications. The risk of postoperative hematoma is associated with extent of operation, greater operative times, age, and male sex. These data may be beneficial in counseling patients and may serve as a benchmark for surgeons to evaluate their practices.