Endocrine Abstracts

Introduction: Thyroidectomy is one of the most common surgerys worldwide. Although a safe procedure, postoperative hematoma is a life threatening complication that requires emergent surgery due to airway compromise. A surgeon must be able to recognize the signs and act accordingly.

Objective: Our goal is to evaluate the risk factors for post-thyroidectomy hematoma requiring emergent reoperation, the symptoms, the source of the bleeding and possible complications.

Materials & methods: 1000 consecutive patients submitted to thyroidectomy in a single Portuguese institution were retrospectively analyzed. Data was then extracted from those who required emergency surgery for post-operative neck hematoma.

Results: Out of 1000 thyroidectomies, 15 patients (1,5%) required emergency surgery for neck hematoma. The majority occured in the first 6 hours but there were cases that presented until 24 hours after. All but 1 had undergone total thyroidectomy. The main presenting symptoms were increase of the cervical diameter, dyspnea, cough and hemorrhage through the suture. The first approach was bed-side re-cervicotomy and evacuation of the blood clots, followed by surgical revision of the hemostasis. All patients were re-intubated with 4 requiring post-operative invasive ventilation and admission in the intensive care unit. No tracheostomy was performed. No patient had long term complications.

Conclusion: Given its life-threatening potential if emergency surgery is not timely performed, risk factors should be preoperatively evaluated to assure patients at risk are closely monitored and preventive measures are taken. All medical staff should be aware of the presenting symptoms and surgeons and anesthesiologists must be able to quickly act to prevent its complications. This is particularly relevant given the popularization of outpatient thyroid surgery which could predict an increase of Emergency Room admissions for cervical hematoma.