Post-Thyroidectomy Hemorrhage: Time, Place, Risk, and the Surgeon

Purpose Post-thyroidectomy hemorrhage has been conducted on re-operated reactive hemorrhage usually occurred within 24 hours. We investigated all hemorrhages including reoperated or not and also secondary hemorrhages occurred after discharge. Methods We retrospectively reviewed 16,701 patients from 1999 to 2019 and investigated the risk factors and time patterns of post-thyroidectomy hemorrhagic events. Results The annual incidence of hemorrhage decreased from 1.7% to 0.1%. The risk factors included age ≥55 years, male sex, body weight ≥60 kg, larger thyroid specimens, and advanced stage (stage III or IV). The type of surgery and body mass index showed no significant associations with the hemorrhagic events. Ligation methods were associated with a greater incidence of hemorrhagic events than energy devices (0.6% vs. 0.3%), but they were not independent predictive factors (odds ratio [OR]=1.5; P=0.157). The OR was high for surgeons experience <3.5 years (OR=1.8), age ≥55 years (OR=1.8), weight ≥60 kg (OR=1.9), and aggressive tumor stage (OR=4.8). The highest OR was observed for Surgeon X s procedures (OR=9.6). Extremely severe airway obstruction was observed in 17% of the patients and one patient did not survive. Most of the hemorrhagic events occurred during hospitalization, but 13% of the events occurred at home after discharge, or in the dialysis chamber of another hospital. Conclusion Post-thyroidectomy hemorrhagic events are life-threatening complications that can occur at unexpected times and places. Delicate hemostasis and careful monitoring even after normal discharge constitute the best approach to prevent these events. Moreover, we do not recommend routine outpatient-based thyroidectomy.