The risk factors for neck hematoma following thyroid surgery: An overview of systematic reviews

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• Neck hematomas are life threatening complications post thyroidectomy. • Multiple risk factors are associated with incidence of hematomas. • Age, gender, grave's disease and hypertension are some of the risk factors found to significantly increase hematoma incidence. Neck hematoma, even though rare, can be a life threatening post-operative complication of thyroid surgery and thus there have been numerous systematic reviews published over the years each evaluating risk factors for neck hematomas. Our review aims to summarize and qualitatively assess evidence from these systematic reviews to provide insight into factors associated with neck hematoma formation post thyroidectomy. We searched Medline (PubMed), Cochrane database of systematic reviews and EBSCO CINAHL for our systematic review. We used Cochrane risk of bias tool for systematic reviews (ROBIS) for quantitative synthesis and risk factors were extracted by demography (age, gender), pre-existing condition (hypertension, malignancy, Grave's disease), previous history (smoking, previous thyroidectomy, anti-thrombotic drugs use), surgical procedure (neck dissection, use of drains, hemostatic agents, unilateral/total thyroidectomy, center volume). We screened a total of 41 systematic reviews and included six which met our inclusion criteria. The common risk factors associated with neck hematoma included age, male gender, hypertension, Grave's disease, anti-thrombotic use, history of prior thyroidectomy, total thyroidectomy, low volume center and neck dissection. The review also suggests that malignancy, smoking, use of neck drain and powered hemostatic agents did not pre-dispose to hematoma formation. The recent evidence in the form of systematic reviews stemming from observational studies has highlighted a few factors that are associated with neck hematoma post thyroidectomy. However, there is a need for good quality-controlled trials to accurately determine the factors associated with neck hematoma.