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:
    • 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 

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