A. Jyot1, T. Pandian1, M. H. Zeb1, N. D. Naik1, A. Chandra1, F. J. Cardenas1, M. Mohan1, E. H. Buckarma1, D. R. Farley1 1Mayo Clinic,General Surgery,Rochester, MINNESOTA, USA
Introduction: Cervical hematoma is a highly dreaded complication of cervical exploration and poses a unique challenge due to the combination of its rarity and associated high mortality. Rising endocrine case volumes over the last decade underscore the need for better understanding of this life threatening condition. We previously reported on the incidence (0.31%) and outcomes of this complication from 1976-2000 (Study A). Given that many of these operations are now performed through smaller incisions and as outpatients, we aim to analyze the complication rate and possible changes in trends from 2001-2015 (Study B).
Methods: A retrospective case-control study including 10,138 patients undergoing thyroidectomy and parathyroidectomy from 2001- 2015 was conducted. Cases were matched 1-to-1 for gender, age, type and year of operation. Univariate analysis testing was performed to assess for baseline discrepancies between study groups followed by a conditional logistic regression to identify perioperative risk factors.
Results: Thirty-two hematomas requiring re-exploration were identified (Study B incidence =0.30%, Study A incidence=0.31%). There were 24 women and 8 men (mean age= 58.4±17.1 years), undergoing thyroidectomy (22), parathyroidectomy (8) and both procedures (2). No perioperative risk factors for developing a cervical hematoma were identified. Most hematomas (n=18, 56%) presented within 6 hours of wound closure, while 7 (22%) presented between 7and 24 hours and 7 (22%) beyond 24 hours. This was in contrast to study A where the most common time of presentation was beyond 6 hours (43%). Neck swelling was the most common presenting symptom (n=22, 69%), followed by neck pain (n=8, 25%), respiratory distress (n=6, 19%), dysphagia (n=6, 19%) and wound discharge (n=4, 13%). At re-exploration, 19 (60%) hematomas were found to be deep and 13 (40%) superficial to the strap muscles. The bleeding source was identified in 24 (75%) cases (11 arterial, 8 venous, 3 diffuse oozing and 2 with oozing and venous bleeding). In our study and control groups, vocal cord paralysis/voice change (25 vs. 22, p=0.171), followed by hypocalcemia (5 vs. 3, p=0.708), were common complications, however no complication reached statistical significance. Mean hospital stay was longer in the patients requiring cervical re-exploration (3.1 days vs. 1.6 days, p=0.005).
Conclusion: The frequency of cervical hematomas remains unaltered over 4 decades. Failure to define a high risk population in the current study highlights the need for meticulous hemostasis. With increasing outpatient neck surgery, scrutiny prior to dismissal and clear patient education regarding symptomatic cervical hematomas is imperative.