A multi-institutional international study of risk factors for hematoma after thyroidectomy

Michael J. Campbell, Kelly L. McCoy, Wen T. Shen, Sally E. Carty, Carrie C. Lubitz, Jacob Moalem, Matthew Nehs, Tammy Holm, David Y. Greenblatt, Danielle Press, Xiaoxi Feng, Allan E. Siperstein, Elliot Mitmaker, Cassandre Benay, Roger Tabah, Sarah C. Oltmann, Herbert Chen, Rebecca S. Sippel, Andrew Brekke, Menno R. VriensLutske Lodewijk, Antonia E. Stephen, Sapna Nagar, Peter Angelos, Maher Ghanem, Jason D. Prescott, Martha A. Zeiger, Patricia Aragon Han, Cord Sturgeon, Dina M. Elaraj, Iain J. Nixon, Snehal G. Patel, Stephen W. Bayles, Rachel Heneghan, Peter Ochieng, Marlon A Guerrero, Daniel T. Ruan

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood. Methods We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy. Results Forty-seven percent of hematoma patients returned to the OR within 6 hours and 79% within 24 hours of their thyroidectomy. On univariate analysis, hematoma patients were older, more likely to be male, smokers, on active antiplatelet/anticoagulation medications, have Graves' disease, a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy, and benign pathology. Hematoma patients also had more blood loss, larger thyroids, lower temperatures, and higher blood pressures postoperatively. On multivariate analysis, independent associations with hematoma were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio, 2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio, 1.97), and increased thyroid mass (odds ratio, 1.01). Conclusion A significant number of patients with a postoperative hematoma present >6 hours after thyroidectomy. Hematoma is associated with patients who have a drain or hemostatic agent, have Graves' disease, are actively using antiplatelet/ anticoagulation medications or have large thyroids. Surgeons should consider these factors when individualizing patient disposition after thyroidectomy.

Original languageEnglish (US)
Pages (from-to)1283-1291
Number of pages9
JournalSurgery
Volume154
Issue number6
DOIs
StatePublished - Dec 2013

Fingerprint

Thyroidectomy
Hematoma
Odds Ratio
Graves Disease
Thyroid Gland
Hemostatics
Operating Rooms
Pathology
Parathyroidectomy
Developed Countries
Case-Control Studies
Multivariate Analysis
Hypertension
Temperature

ASJC Scopus subject areas

  • Surgery

Cite this

Campbell, M. J., McCoy, K. L., Shen, W. T., Carty, S. E., Lubitz, C. C., Moalem, J., ... Ruan, D. T. (2013). A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery, 154(6), 1283-1291. https://doi.org/10.1016/j.surg.2013.06.032

A multi-institutional international study of risk factors for hematoma after thyroidectomy. / Campbell, Michael J.; McCoy, Kelly L.; Shen, Wen T.; Carty, Sally E.; Lubitz, Carrie C.; Moalem, Jacob; Nehs, Matthew; Holm, Tammy; Greenblatt, David Y.; Press, Danielle; Feng, Xiaoxi; Siperstein, Allan E.; Mitmaker, Elliot; Benay, Cassandre; Tabah, Roger; Oltmann, Sarah C.; Chen, Herbert; Sippel, Rebecca S.; Brekke, Andrew; Vriens, Menno R.; Lodewijk, Lutske; Stephen, Antonia E.; Nagar, Sapna; Angelos, Peter; Ghanem, Maher; Prescott, Jason D.; Zeiger, Martha A.; Aragon Han, Patricia; Sturgeon, Cord; Elaraj, Dina M.; Nixon, Iain J.; Patel, Snehal G.; Bayles, Stephen W.; Heneghan, Rachel; Ochieng, Peter; Guerrero, Marlon A; Ruan, Daniel T.

In: Surgery, Vol. 154, No. 6, 12.2013, p. 1283-1291.

Research output: Contribution to journalArticle

Campbell, MJ, McCoy, KL, Shen, WT, Carty, SE, Lubitz, CC, Moalem, J, Nehs, M, Holm, T, Greenblatt, DY, Press, D, Feng, X, Siperstein, AE, Mitmaker, E, Benay, C, Tabah, R, Oltmann, SC, Chen, H, Sippel, RS, Brekke, A, Vriens, MR, Lodewijk, L, Stephen, AE, Nagar, S, Angelos, P, Ghanem, M, Prescott, JD, Zeiger, MA, Aragon Han, P, Sturgeon, C, Elaraj, DM, Nixon, IJ, Patel, SG, Bayles, SW, Heneghan, R, Ochieng, P, Guerrero, MA & Ruan, DT 2013, 'A multi-institutional international study of risk factors for hematoma after thyroidectomy', Surgery, vol. 154, no. 6, pp. 1283-1291. https://doi.org/10.1016/j.surg.2013.06.032
Campbell MJ, McCoy KL, Shen WT, Carty SE, Lubitz CC, Moalem J et al. A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery. 2013 Dec;154(6):1283-1291. https://doi.org/10.1016/j.surg.2013.06.032
Campbell, Michael J. ; McCoy, Kelly L. ; Shen, Wen T. ; Carty, Sally E. ; Lubitz, Carrie C. ; Moalem, Jacob ; Nehs, Matthew ; Holm, Tammy ; Greenblatt, David Y. ; Press, Danielle ; Feng, Xiaoxi ; Siperstein, Allan E. ; Mitmaker, Elliot ; Benay, Cassandre ; Tabah, Roger ; Oltmann, Sarah C. ; Chen, Herbert ; Sippel, Rebecca S. ; Brekke, Andrew ; Vriens, Menno R. ; Lodewijk, Lutske ; Stephen, Antonia E. ; Nagar, Sapna ; Angelos, Peter ; Ghanem, Maher ; Prescott, Jason D. ; Zeiger, Martha A. ; Aragon Han, Patricia ; Sturgeon, Cord ; Elaraj, Dina M. ; Nixon, Iain J. ; Patel, Snehal G. ; Bayles, Stephen W. ; Heneghan, Rachel ; Ochieng, Peter ; Guerrero, Marlon A ; Ruan, Daniel T. / A multi-institutional international study of risk factors for hematoma after thyroidectomy. In: Surgery. 2013 ; Vol. 154, No. 6. pp. 1283-1291.
@article{4b13772bfab94043ad74ae393ad63cb8,
title = "A multi-institutional international study of risk factors for hematoma after thyroidectomy",
abstract = "Background Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood. Methods We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy. Results Forty-seven percent of hematoma patients returned to the OR within 6 hours and 79{\%} within 24 hours of their thyroidectomy. On univariate analysis, hematoma patients were older, more likely to be male, smokers, on active antiplatelet/anticoagulation medications, have Graves' disease, a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy, and benign pathology. Hematoma patients also had more blood loss, larger thyroids, lower temperatures, and higher blood pressures postoperatively. On multivariate analysis, independent associations with hematoma were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio, 2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio, 1.97), and increased thyroid mass (odds ratio, 1.01). Conclusion A significant number of patients with a postoperative hematoma present >6 hours after thyroidectomy. Hematoma is associated with patients who have a drain or hemostatic agent, have Graves' disease, are actively using antiplatelet/ anticoagulation medications or have large thyroids. Surgeons should consider these factors when individualizing patient disposition after thyroidectomy.",
author = "Campbell, {Michael J.} and McCoy, {Kelly L.} and Shen, {Wen T.} and Carty, {Sally E.} and Lubitz, {Carrie C.} and Jacob Moalem and Matthew Nehs and Tammy Holm and Greenblatt, {David Y.} and Danielle Press and Xiaoxi Feng and Siperstein, {Allan E.} and Elliot Mitmaker and Cassandre Benay and Roger Tabah and Oltmann, {Sarah C.} and Herbert Chen and Sippel, {Rebecca S.} and Andrew Brekke and Vriens, {Menno R.} and Lutske Lodewijk and Stephen, {Antonia E.} and Sapna Nagar and Peter Angelos and Maher Ghanem and Prescott, {Jason D.} and Zeiger, {Martha A.} and {Aragon Han}, Patricia and Cord Sturgeon and Elaraj, {Dina M.} and Nixon, {Iain J.} and Patel, {Snehal G.} and Bayles, {Stephen W.} and Rachel Heneghan and Peter Ochieng and Guerrero, {Marlon A} and Ruan, {Daniel T.}",
year = "2013",
month = "12",
doi = "10.1016/j.surg.2013.06.032",
language = "English (US)",
volume = "154",
pages = "1283--1291",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - A multi-institutional international study of risk factors for hematoma after thyroidectomy

AU - Campbell, Michael J.

AU - McCoy, Kelly L.

AU - Shen, Wen T.

AU - Carty, Sally E.

AU - Lubitz, Carrie C.

AU - Moalem, Jacob

AU - Nehs, Matthew

AU - Holm, Tammy

AU - Greenblatt, David Y.

AU - Press, Danielle

AU - Feng, Xiaoxi

AU - Siperstein, Allan E.

AU - Mitmaker, Elliot

AU - Benay, Cassandre

AU - Tabah, Roger

AU - Oltmann, Sarah C.

AU - Chen, Herbert

AU - Sippel, Rebecca S.

AU - Brekke, Andrew

AU - Vriens, Menno R.

AU - Lodewijk, Lutske

AU - Stephen, Antonia E.

AU - Nagar, Sapna

AU - Angelos, Peter

AU - Ghanem, Maher

AU - Prescott, Jason D.

AU - Zeiger, Martha A.

AU - Aragon Han, Patricia

AU - Sturgeon, Cord

AU - Elaraj, Dina M.

AU - Nixon, Iain J.

AU - Patel, Snehal G.

AU - Bayles, Stephen W.

AU - Heneghan, Rachel

AU - Ochieng, Peter

AU - Guerrero, Marlon A

AU - Ruan, Daniel T.

PY - 2013/12

Y1 - 2013/12

N2 - Background Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood. Methods We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy. Results Forty-seven percent of hematoma patients returned to the OR within 6 hours and 79% within 24 hours of their thyroidectomy. On univariate analysis, hematoma patients were older, more likely to be male, smokers, on active antiplatelet/anticoagulation medications, have Graves' disease, a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy, and benign pathology. Hematoma patients also had more blood loss, larger thyroids, lower temperatures, and higher blood pressures postoperatively. On multivariate analysis, independent associations with hematoma were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio, 2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio, 1.97), and increased thyroid mass (odds ratio, 1.01). Conclusion A significant number of patients with a postoperative hematoma present >6 hours after thyroidectomy. Hematoma is associated with patients who have a drain or hemostatic agent, have Graves' disease, are actively using antiplatelet/ anticoagulation medications or have large thyroids. Surgeons should consider these factors when individualizing patient disposition after thyroidectomy.

AB - Background Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood. Methods We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy. Results Forty-seven percent of hematoma patients returned to the OR within 6 hours and 79% within 24 hours of their thyroidectomy. On univariate analysis, hematoma patients were older, more likely to be male, smokers, on active antiplatelet/anticoagulation medications, have Graves' disease, a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy, and benign pathology. Hematoma patients also had more blood loss, larger thyroids, lower temperatures, and higher blood pressures postoperatively. On multivariate analysis, independent associations with hematoma were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio, 2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio, 1.97), and increased thyroid mass (odds ratio, 1.01). Conclusion A significant number of patients with a postoperative hematoma present >6 hours after thyroidectomy. Hematoma is associated with patients who have a drain or hemostatic agent, have Graves' disease, are actively using antiplatelet/ anticoagulation medications or have large thyroids. Surgeons should consider these factors when individualizing patient disposition after thyroidectomy.

UR - http://www.scopus.com/inward/record.url?scp=84887998751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887998751&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2013.06.032

DO - 10.1016/j.surg.2013.06.032

M3 - Article

C2 - 24206619

AN - SCOPUS:84887998751

VL - 154

SP - 1283

EP - 1291

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 6

ER -