Neck Hematoma Research Articles

Practice variations, trends, and outcomes of drain use in thyroidectomy: A NSQIP study

BackgroundThe benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy. MethodThis is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016–2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)–primary outcome, and length-of-stay (LOS)–secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses. ResultsOf 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91–3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51–10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05). ConclusionDrain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.

Postoperative Bleeding Complications are Common among Patients Undergoing Transcarotid Artery Revascularization

Current practice guidelines recommend dual antiplatelet therapy for at least 30 days postoperatively after transcarotid artery revascularization (TCAR) to promote stent patency. However, many patients are already taking other antithrombotic medications. The optimal pharmacologic regimen in this patient population remains unclear, especially as it pertains to postoperative bleeding complications. All TCAR procedures performed at a large academic medical center from January 1, 2017 to April 30, 2023 were identified via current procedural terminology codes and retrospectively reviewed via electronic medical records. Data were collected on patient demographics, procedural details, postoperative complications, and antithrombotic regimen. Bleeding complications were categorized as surgical and non-surgical, which included any bleeding diatheses that were not related to the neck incision, such as epistaxis, hematuria, melena, or non-cervical hematoma. A total of 116 TCAR procedures were performed. The 30-day incidence of bleeding complications was 12.1% (n=14), which included 8 (6.9%) symptomatic neck hematomas and 6 (5.2%) non-surgical site bleeding complications. Aside from patient age (median 72 y [66-79] vs 79 y [70.5-88], p=0.03), demographics, medical comorbidities, surgical indication, risk-related indication for TCAR, and inpatient/outpatient status were similar between patients who experienced bleeding versus no bleeding complications. Patients who developed bleeding complications experienced higher thirty-day hospital readmission (42.9% vs 9.8%, p<0.001) and reintervention rates (21.4% vs 2.0%, p<0.001) and trended towards longer postoperative length of stay (1.5 d [1-3] vs 1 [1-2] d, p=0.07). Reasons for readmission (n=16) included: epistaxis (1), hematuria (1), headache and melena (1), melena and myocardial infarction (1), fall (1), headache (1), dyspnea (5), delirium (1), diarrhea (1), atrial fibrillation (1), and neck hematoma (1); one patient did not have a readmission reason documented. Reinterventions (n=6) included: neck hematoma evacuation (2), epistaxis cauterization (1), emergent cricothyroidotomy (1), and repeat carotid stenting (1). The management of antithrombotic medications during bleeding events were highly variable amongst providers (11 patients with nothing held, one apixaban held, one aspirin held, one clopidogrel held), however, no patients suffered carotid stent thrombosis. Bleeding complications are common within 30 days of TCAR and frequently result in unplanned hospital readmission and reintervention. There is significant provider-level variability in management of antithrombotic medications during these events. These data highlight need for evidence-based guidelines for the optimal pharmacologic strategy for patients post-TCAR who develop bleeding complications.

Difficult intubation in critical patient: how can we manage it? a case report

Difficult airway management represents a challenge. Guidelines recommend choosing the airway technique based on physicians’ skills, equipment, available devices and context. A man with acute respiratory failure needed an emergent intubation. He was obese with Mallampati score 4, Cormack-Lehane grading 4, macroglossia, reduced mouth opening, stocky and wide neck, and deviated laryngo-tracheal axis due to expanding neck hematoma. After endotracheal intubation failure, the anesthetist placed a second-generation laryngeal mask airway and started ventilation. In the next step, definite airway was provided by an endotracheal tube placed through the mask under flexible fiberscope vision. Supraglottic airway devices are recommended in cases of unanticipated difficult intubation after endotracheal intubation failure. They are used to ensure satisfactory oxygenation and occasionally to guide the endotracheal tube. Fiberscope is useful to ensure vision of larynx and trachea in these scenarios. This is a unique case of emergency and difficult airway management using this combined approach.

Traumatic occipital artery pseudoaneurysm: Case report, anatomical considerations, and literature review.

We describe a case of a 22-year-old man with a traumatic occipital artery pseudoaneurysm revealed by a painful expanding neck hematoma after a penetrating knife injury. A neuroendovascular consultation was requested after a computed tomography angiogram showed active pseudoaneurysm bleeding. Anatomical considerations of the upper cervical region including dangerous anastomosis between the vertebral and internal carotid artery are discussed, illustrating how this impacted our treatment strategy. We also discuss other treatment modalities after a thorough literature review of traumatic occipital artery pseudoaneurysms.

Development of Airway Hemorrhage Simulation Scenarios With Pilot of an Airway Team Leader Assessment Tool.

Airway hemorrhage requires rapid treatment to prevent adverse patient outcomes. Simulation education programs are challenged to recreate learning environments with adequate fidelity for team management of airway hemorrhage. We developed Airway Hemorrhage Simulation Scenarios consisting of low-cost partial-task simulators to mimic airway hemorrhage (nasopharyngeal, oropharyngeal, expanding neck hematoma) and multiple methods to assess team leader performance in emergent airway management [Airway Team Leader Assessment Tool (ATLAT), Airway Checklist Performance, and Global Performance Rating]. We assigned trainees in Emergency Medicine (EM) and Critical Care (CC) sequentially to 1 of the 3 possible hemorrhage scenarios, and each trainee participated in a single 1-hour session composed of 3 repeated opportunities of deliberate practice of the assigned scenario. We assessed the trainees after session 1 and session 3 with independent expert evaluators of trainee performance using the ATLAT, Airway Checklist Performance, and Global Performance Rating. We collected data on 26 trainees: 19 EM residents [postgraduate year (PGY) 1-3] and 7 CC fellows (PGY 4-7). Trainees had significant improvement for all ATLAT domain measures, Airway Checklist Total Score, and Global Performance Rating between session 1 and session 3. Our pilot evaluation suggests that deliberate practice of Airway Hemorrhage Simulation Scenarios improves airway team leader performance from multiple disciplines in managing high-acuity, low-occurrence airway hemorrhage.

From routine to rescue: Thyroidectomy for life-threatening thyrotoxicosis.

Thyroidectomies are routinely same-day elective procedures. The aim of this study was to investigate outcomes in patients who underwent uncommon urgent thyroidectomy. We retrospectively reviewed patients diagnosed with thyrotoxicosis at a quaternary medical center between 2011 and 2023. Included patients were admitted nonelectively with thyroidectomies performed during same hospital stay. Patient demographics, comorbidities, hospital course, and operative outcomes were analyzed. Thirty patients met the inclusion criteria. The majority were female (60%) and Black (60%) with a mean age of 41±14years. At admission, 76.6% had undetectable thyrotropin levels (<0.01µU/mL) and 26.7% were diagnosed with thyroid storm. Common presenting comorbidities included atrial fibrillation (53.3%), heart failure (40%), and liver failure (16.7%). Graves' disease was diagnosed in 83.3% of patients, while 13.3% had amiodarone-induced thyrotoxicosis. Median hospital stay before surgery was 8days (interquartile range: 4-16). Indications for surgery were adverse medication events (30%), inadequate therapeutic effect by medication (30%), and worsening heart failure (26.7%). Postoperatively, 6.7% required reoperation for neck hematoma, 13.3% experienced temporary hypoparathyroidism, and 6.7% had hoarseness. Following surgery, 50% of patients with atrial fibrillation experienced resolution and 50% with heart failure with reduced ejection fraction showed ultrasonic improvement. Within 30days, 20% visited the emergency department, none due to thyroidectomy complications, and 13.3% were readmitted for comorbidities. One patient (3.3%) died from liver failure. Patients who require an urgent thyroidectomy often have life-threatening comorbidities particularly cardiac disease. Performing thyroidectomy in these patients can potentially create clinical homeostasis for further management of their comorbidities.

Safety of thyroidectomy in hospitalized patients: A descriptive analysis of the NSQIP thyroidectomy-targeted data

BackgroundSome patients undergo thyroidectomy while hospitalized for a related or independent indication. Outcomes have not been described in this group. MethodsThe 2016–2018 thyroidectomy-targeted NSQIP datasets were queried for patients admitted for ≥1 day preoperatively. 1:1 propensity score matching was employed to compare the outcomes of admitted patients to outpatients, including surgical and thyroidectomy-specific outcomes. Multivariable logistic regression determined factors associated with poor outcomes. ResultsOf 18,078 patients, 312 were admitted at least 1 day prior to surgery. Inpatients had higher ASA classifications and rates of several comorbidities compared to the general population. After propensity score matching, inpatients had higher rates of overall complications, unplanned reoperation, and bleeding. They also experienced higher rates of thyroidectomy-specific complications such as hypocalcemia and neck hematoma. By multivariable regression, admission prior to surgery was associated with development of any complications. ConclusionThyroidectomy in hospitalized patients carries an increased risk of complications. Patients requiring thyroidectomy while already hospitalized should be counseled accordingly.

Feasibility analysis of the application of programmed process endoscopic lateral neck dissection via chest-breast approach in papillary thyroid carcinoma surgery

Objective: To explore the feasibility of endoscopic lymph node dissection(LND) with programmed breast approach for the treatment of papillary thyroid cancer. Methods: A case series study. The clinical data of 39 patients with papillary thyroid cancer who underwent endoscopic LND treatment with programmed breast approach in Shenzhen People's Hospital from January to November 2022 were retrospectively analyzed. There were 10 males and 29 females, aged (35.95±10.17) years. LND time, total surgical time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay and postoperative complications were analyzed. Results: Among 39 patients, there were 18 cases of unilateral thyroid cancer, 21 cases of bilateral thyroid cancer, 35 cases of unilateral LND, and 4 cases of bilateral LND. The maximum diameter of thyroid cancer lesions was (1.48±0.69) cm, and the maximum diameter of lymph node metastases was (1.63±0.58)cm. The operative time of unilateral neck dissection was (124.11±19.92) min (102-170 min), and the total operative time was (226.42±55.68) min (110-390 min). The number of lymph nodes cleaned was (32.40±10.44)(12-54), the number of metastasis and detection was 207/1 393. The postoperative drainage volume was (174.64±82.33) ml(41-350 ml). There were no neck hematomas, no skin burns or no shrugging disorders in the postoperative period. There were 7 cases of numbness and discomfort in neck skin sensation, which gradually relieved after half a year. Postoperative discharge time (4.77±1.94) d(3-15 d). Conclusion: It is safe and feasible to treat papillary thyroid cancer with endoscopic LND with programmed breast approach, which can improve surgical efficiency and clinical application value.

Is the Use of Dexmedetomidine Upon Emergence From Anesthesia Associated With Neck Hematoma Formation Following Head and Neck Microvascular Reconstruction?

Dexmedetomidine (DEX) is a highly selective alpha-2-receptor agonist, and its use has not been well studied in major microvascular reconstructive surgery of the head and neck. The purpose is to measure the association between DEX and neck hematoma formation in subjects undergoing head and neck microvascular reconstructive surgery. The investigators implemented a retrospective cohort study on subjects undergoing microvascular head and neck reconstruction for benign and malignant pathology at the University of Alabama at Birmingham from 2014 to 2021. Patients with unresectable tumors were excluded. The predictor variable was the intraoperative use of DEX upon emergence from general anesthesia. Subjects received standard anesthetic drugs and DEX, while control subjects received only standard anesthetic drugs. The primary outcome was postoperative neck hematoma formation necessitating a return to the operating theater. The secondary outcome was the length of stay (LOS). The covariates were demographic, operative, and oral morphine equivalents of anesthesia drugs. Bivariate analyses were performed using the Student's t-test and the χ2 test for continuous and categorical variables. Multivariate regression analyses were conducted to assess for associations between DEX and the outcomes adjusted for confounding variables when present. P values of < .05 were regarded as statistically significant. A total of 297 subjects (mean age, 59.6years, and standard deviation [SD], 14.9) with 61.6% male received DEX, and 304 subjects (mean age, 58.9years, and SD, 14.6) with 60.2% male served as controls (P>.5). A total of 11 postoperative neck hematoma occurred in the control group when compared to 2 in the DEX (relative risk=5.4, 95% confidence interval [CI], 1.2 to 24, P=.02). The mean LOS was 7.7 (SD, 4.3) and 9.4 (SD, 8.1) for the DEX and control groups (95% CI, 0.7 to 2.8, P<.01). After adjusting for tobacco history, tracheostomy, and neck dissection, DEX (Beta coefficient (B)=-1.7, 95% CI -2.7 to -0.7, P<.01) and neck dissection (B=2.2, 95% CI 1.0 to 3.4, P<.01) were statistically associated with LOS. The use of intraoperative DEX upon emergence from general anesthesia was associated with lower postoperative neck hematoma formation and a shorter length of stay following microvascular head and neck reconstruction.

Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review

The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P= 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P= 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P= 0.001). In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.

Bridging the gap: a simulation-based education programme to improve the management of postoperative neck haematomas

Postoperative neck haematomas have a reported incidence of 3.4%. They result in a longer length of hospital stay, higher costs and a higher mortality rate. Consensus guidelines provide an algorithm for the management of a suspected neck haematoma and recommend that staff are trained to recognise the symptoms and signs of a neck haematoma. They also suggest the introduction of a post thyroid surgery emergency box. Our aims were to provide education in the form of simulation scenarios and to introduce a neck haematoma evacuation box. This quality improvement project was carried out in a large tertiary referral hospital, with over 1000 beds. It is the major head and neck surgical centre in Ireland. Ethical approval was granted by the hospital. Four simulation training sessions were carried out with Ear, Nose and Throat (ENT) nurses and interns. Voluntary surveys were conducted before and after the sessions. A sample neck haematoma evacuation box was used for the simulation scenarios. 50 staff participated in simulation training. 7% of staff had seen a neck being evacuated on the ward. 37% had received prior teaching on the management of neck haematomas. Significantly more participants reported to know the symptoms and signs of a neck haematoma and the required management of a neck haematoma after completion of the simulation sessions. All participants agreed neck haematoma evacuation boxes were necessary and would improve patient outcomes. The pre-simulation survey demonstrated that an unacceptably low amount of staff had previous training on this topic. Simulation training resulted in more participants being able to identify the signs and symptoms of a neck haematoma and more participants feeling confident regarding the necessary actions. The results show the positive impact of simulation training and provide a basis for advocating for this training to continue on a regular basis. Simulation works to increase participants confidence and familiarity with a given situation. Simulation training also improves technical skills and teamwork. There was unanimous support for the introduction of the post neck surgery haematoma evacuation boxes, which suggests that these would be a valuable introduction in our hospital.

Nutritional management of sepsis secondary to infective acute gastroenteritis with diabetes

ABSTRACT A 36-year-old Chinese male was presented at the emergency department and admitted to the Geriatric Intensive Care Unit for severe diabetic ketoacidosis (DKA) secondary to acute gastroenteritis (AGE) with symptoms of severe vomiting and diarrhoea. He had underlying maturity-onset diabetes of the young, hypertension, dihydrolipoamide dehydrogenase dihydrolipoamide dehydrogenase (DLD) and chronic kidney disease Stage 3 and had a history of hospital admission for the episodes of hypoglycaemia. The current diagnosis was sepsis secondary to infective AGE, resolved DKA, non-oliguric acute kidney injury, neck haematoma and left-hand cellulitis. He was referred to dietitian for diabetic counselling. His calculated body mass index was 19.4 kg/m2 (normal) with no history of fat and muscle loss. The biochemical data showed abnormalities for glycated haemoglobin, renal profile, liver function test and full blood count.

Abstract 252: The outcomes and complications in patients undergoing subclavian‐carotid artery bypass surgery: A case series

Introduction Endovascular intervention has become the mainstay of treatment for acute ischemic stroke. However, in certain cases, open surgery is the only option to achieve revascularization. This study presented two patients with symptomatic common carotid artery occlusion (CCAO) who subsequently underwent subclavian‐carotid artery bypass surgery using the polytetrafluorethylene graft. The complications of the procedure and patient’s outcomes were discussed. Methods We identified two patients who were admitted to our medical center between January 2022 to December 2022 for subclavian‐carotid artery bypass procedure. Clinical data were reviewed retrospectively. Results Case 1. A 69‐year‐old woman with a history of lung cancer, hypertension, chronic tobacco use, atherosclerosis, and known calcified plaque at the left carotid bifurcation on dual antiplatelet therapy presented with acute onset of expressive aphasia and right hemiparesis due to acute left CCAO. Endovascular procedure was deferred due to difficult arterial access. An endarterectomy of CCA, eversion endarterectomy of external carotid artery, and subclavian‐carotid artery bypass surgery were performed. She developed neck hematoma post‐operatively, requiring evacuation. She was discharged to acute rehabilitation facility and eventually home. Six months after surgery, she still had severe expressive aphasia and spasticity of the right arm and leg (Figure A‐C). Case 2. A 79‐year‐old man with a strong family history of arterial dissection, hypertension, coronary artery disease, and obesity experienced intense chest pain and left hemiparesis secondary to Type A aortic dissection with extension from the innominate artery to the right carotid bifurcation. Endovascular intervention was deferred given the angulation of aortic arch after surgical repair. Decision was made to perform subclavian‐carotid artery bypass surgery. Post‐operatively, he had evacuation of neck hematoma. He also had tracheostomy and gastrostomy tube placement prior to discharge to skilled nursing facility. At 6‐month follow up, he could ambulate with a walker and oral diet was resumed (Figure D‐F). Conclusion CCAO is a rare condition, and there is no prospective randomized trial that compares various treatment strategies for symptomatic CCAO. Consistent with the findings of our study, bypass surgeries have been shown as an effective treatment to prevent further ischemic infarct in patients with symptomatic CCAO. Both patients in our study survived at 6‐month follow up with no recurrence of stroke. Additionally, no other surgical complications were noted except for neck hematoma. Bypass surgery was performed as a salvage procedure for both patients after they suffered from stroke. Early identification of CCAO and collaboration between vascular surgeon and endovascular interventionist would maximize the benefit of this life‐saving procedure to the appropriate candidates.

Initial experience with transcarotid arterial revascularization with flow reversal in the management of symptomatic carotid stenosis.

The aim of this study was to evaluate the efficacy of transcarotid arterial revascularization (TCAR) as a viable intervention in the treatment of symptomatic carotid artery stenosis. The authors performed a retrospective review of prospectively collected data of the first 62 consecutive patients treated at Rhode Island Hospital in Providence, Rhode Island, who underwent a TCAR for symptomatic carotid artery stenosis between November 11, 2020, and March 31, 2022. Relevant demographic, comorbidity, and perioperative data were extracted through retrospective chart review. Patients with asymptomatic carotid artery stenosis were excluded. The authors also evaluated patients using pertinent physiological and anatomical high-risk criteria as described in the ROADSTER trial. Risk factors were aggregated to form a composite risk total for every patient. The primary outcome of this study was the 30-day adverse outcome rate of stroke, myocardial infarction, and/or death. Periprocedural stroke was identified by clinical symptoms and radiographic findings. Secondary endpoints included device and procedural success, 30-day mortality, 30-day stroke rate, and postoperative complications. The authors analyzed the first 62 patients with > 50% symptomatic carotid artery stenosis who underwent TCAR at their institution. The mean age of the cohort was 71.5 years, and the cohort was predominantly male (67.7%). The most common high-risk medical criteria were age older than 75 years (45.3%) and severe coronary artery disease (13.6%). The most common anatomical high-risk criteria were high bifurcation (35.1%) and contralateral stenosis requiring treatment within 30 days (15.8%). Fifty percent of patients had at least 1 medical high-risk criterion, 50% had at least 1 anatomical risk criterion, and 82% of patients had 2 or more high-risk criteria of any kind. Among this group, all patients (100%) underwent successful revascularization, with 1 (1.6%) requiring intraprocedural conversion to carotid endarterectomy. Postprocedurally, there was 1 nondisabling stroke (1.6%) and 3 deaths (4.8%) within 30 days of the procedure, with only 1 death directly attributable to the procedure. One patient (1.6%) experienced a neck hematoma. In total, 4 patients (6.5%) experienced a major complication. The overall complication rate was 8.0%. The authors' initial experience with TCAR suggests that it might provide an effective alternative to carotid endarterectomy and carotid artery stenting in the management of symptomatic carotid stenosis in patients with high-risk anatomical and medical characteristics.

A100Simulating to manage post thyroidectomy haematoma safely: Improving fidelity whilst reducing cost

Simulation training sessions were designed at the University Hospital of Wales in order to implement the new national guidelines for the management of suspected haematoma following thyroid surgery [1]. Opportunities included on site portable training with a part task trainer and high-fidelity scenarios simulating patient deterioration following thyroid surgery in an immersive environment. Our initial design for the high-fidelity set-up included a simulated neck haematoma achieved by using a second generation supraglottic airway device (SAD) with an inflatable cuff placed in the manikin’s neck with the laryngeal opening outwards and tubing inside the chest. The opening was filled with red jelly, covered by simulated strap muscles (made from simulated small bowel with interrupted sutures) and simulated neck skin (which presented a sutured incision complete with steri-strips). Ongoing bleeding was simulated by injecting liquid jelly through the SAD’s gastric port via a long connecting tube in the manikin’s thorax. This simulation training increased confidence and familiarity with the steps required to manage post thyroid surgery haematomas in 100% (15/15) of candidates, with 73% grading the mannikin ≥4/5 for realism. However, it was costly to provide and time-consuming to set up. It was decided to try to make the set-up cheaper and easier to reproduce without impairing quality. Equipment costs were reviewed and alternative options identified. Expensive components included the SAD and bowel material, which were replaced with a cheaper SAD and a disposable tourniquet fashioned as shown in Making the simulation larynx and strap muscles. A step by step guide The cost of disposable props used in each session was reduced from £133.04 to £8.52 with the new equipment. The designers also felt it was significantly more robust and easier to reproduce. This approach could also be easily adapted for mobile part-task training, improving multi-disciplinary access to training. Feedback showed 47% of candidates felt the new set-up to be better, and 47% reported non-inferiority. Changing to new equipment resulted in a design that was significantly cheaper, easier to source and set-up, while being at least as realistic and offering training opportunities outside the high-fidelity environment. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Detection of neck hematoma after carotid endarterectomy by chest X-ray

Detection of neck hematoma after carotid endarterectomy by chest X-ray

Predictors and Preventive Strategies of Bleeding After Thyroid Surgery.

Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.

The outcome of ultrasound-guided insertion of central hemodialysis catheter.

To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients. This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk. All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion. Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.

Impact of Ultrasound Guidance During Placement of Tunnel Dialysis Catheter

Objective: To determine incidence of neck hematoma between with and without ultrasound guided placement of internal jugular vein tunnel dialysis catheter Methodology: A retrospective study was conducted at Heart and Vascular Institution, Kulsum International Hospital, Islamabad. Period: Six months from October 2021 to March 2022. Patients, who presented with End Stage renal failure requiring tunnel dialysis catheter for hemodialysis, were included into this retrospective study. Patient’s statistic profile, indications, signs and symptoms were recorded. Tunnel dialysis catheters were placed through internal jugular vein with or without ultrasound guidance. The study's outcome was measured in terms of the incidence of neck hematoma compared between the two study groups. Results: Overall, out of twenty patients, 13 (65.0%) were male and 7 (35.0%) were female. Age ranged from 16 to 70 with average of 51.0 ± 16.2 years. The incidence of neck hematoma was 3 (30.0%) in internal jugular vein tunnel dialysis catheter placement without ultrasound guidance (group B) compared to none 0 (0.0%) in patients undergoing internal jugular vein tunnel dialysis catheterization with ultrasound guidance (group A). Conclusion: The incidence of neck hematoma was 30% which can be reduced to 0% if ultrasound is used as guidance in cannulation of internal jugular vein during the placement of tunnel dialysis catheter.

Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Bleeding and Wound Events after Thyroid Surgery.

Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue.