C.A. Annesi1, A. Gillis1, J.M. Fazendin1, B. Lindeman1, H. Chen1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Central neck hematomas after thyroidectomy and parathyroidectomy are rare but potentially life-threatening events. Many surgeons are reluctant to perform these operations in an ambulatory facility with same day discharge due to this fear, and commonly admit patients for 24 hours or more for observation. However, in underserved areas as well as seen during the COVID-19 pandemic, surgical cases are limited due to lack of hospital beds. Therefore, we reviewed the incidence and timing of central neck hematomas after thyroid and parathyroid surgery at our institution.
Methods: A prospective database of parathyroid and thyroid operations with 3787 patients were reviewed. All cases of post-operative central neck hematomas had chart re-reviewed.
Results: The rate of central neck hematoma was 0.2% (9/3787 patients). Hematomas were slightly more common after thyroidectomy (0.6%) compared to parathyroidectomy (0.1%, Figure). Of all the patients with hematomas, 22% occurred in the post-anesthesia care unit (PACU) and the 67% occurred more than 48 hours after surgery. Importantly, only one central neck hematomas occurred within 24 hours after discharge from the PACU. Of the 67% with delayed hematomas, they required hematoma evacuation at post-operative days 2, 3, 4, 6 and 9. There were no hematoma-related morbidity or mortality. All patients had risk factors for post-operative hematoma including anticoagulation/anti-platelet therapy (67%) and Graves’ disease (33%).
Conclusion: In this series, all but one central neck hematoma after thyroid and parathyroid surgery occurred either immediately in the PACU or were delayed after 48 hours. All patients were effectively managed with operative hematoma evacuation without mortality. In resource-challenged environments, thyroid and parathyroid surgery can be safely performed in an ambulatory setting without the need for 24-hour admissions for observation.