Bleeding Post Thyroidectomy

• The incidence of symptomatic hemorrhage:
  • Requiring reintervention amounts to 0.1% to 1.5%
• Post-operative bleeding will characteristically be prefaced by:
  • Respiratory distress
  • Pain
  • Cervical pressure
  • Dysphagia
  • Increased blood drainage
• No specific perioperative risk factors:
  • That would allow identification of the high-risk patient population for this potentially lethal complication are known
• High surgical volume:
  • Does not reduce the incidence of hematoma formation:
    • Consequently, the key issue of prevention is:
      • Attention to anatomic detail and careful hemostasis during surgery
• If the surgeon is uncertain about the dryness of the operative field:
  • A Valsalva maneuver:
    • Which elevates the intrapulmonary pressure to 40 cm H20:
      • Facilitates recognition of bleeding vessels:
        • Can be performed prior to wound closure
• Routine use of suction drains:
  • Does not prevent postoperative cervical bleeding
• In the majority of patients, symptomatic hemorrhage:
  • Occurs between 6 and 12 hours after the initial operation
• Since in approximately 20% of cases the onset of hematoma symptoms:
  • Is reported beyond 24 hours postoperatively:
    • Ambulatory surgery with a 4- to 8-hour observation period might harbor risk of delayed intervention
• Once recognized:
  • The wound should be deliberately re-opened, and the hematoma evacuated
• In case of significant respiratory distress:
  • Emergency bedside hematoma evacuation, if necessary, in combination with endotracheal intubation, is required
  • The requirement for tracheotomy either in the emergency setting or due to persisting airway obstruction after hematoma removal is generally a rare event
• Reference:
  • Burkey SH, et al (2001) Reexploration for symptomatic he- matomas after cervical exploration. Surgery 130:914–920