Nathalie Chereau1,2, Gaelle Godiris-Petit3, Severine Noullet3, Sophie Di Maria4, Sophie Tezenas du Montcel5, Fabrice Menegaux3,6. 1. Department of Endocrine and Digestive Surgery, Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. nathalie.chereau@aphp.fr. 2. Groupe de recherche clinique n: 16 Thyroid Tumors, Sorbonne University, Paris, France. nathalie.chereau@aphp.fr. 3. Department of Endocrine and Digestive Surgery, Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 4. Department of Anesthesiology, Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, 75013, Paris, France. 5. INSERM, Institut Pierre Louis d'Epidemiologie et de Santé Publique, Hospital Pitié Salpêtriere, APHP, Sorbonne University, 75013, Paris, France. 6. Groupe de recherche clinique n: 16 Thyroid Tumors, Sorbonne University, Paris, France.
Abstract
BACKGROUND: The risk of postoperative compressive hematoma is the major limitation for a wide development of ambulatory thyroidectomy (AT). The aim of this study was to establish a risk score of hematoma on the basis of preoperative criteria. METHODS: All patients who underwent thyroidectomy between 2002 and 2017 were reviewed in a high-volume endocrine surgery center. Multivariate analysis of risk factors associated with hematoma was performed in lobectomy and total thyroidectomy (TT). We assigned the risk factors identified by multivariate analysis weighted points proportional to the regression coefficient values. A simple sum of all accumulated points for each patient calculated the total score. RESULTS: For lobectomy [31 hematoma among 3912 patients (0.8%)], the weighted points of Vit K antagonist (VKA) were 3 (OR 9.86), and 1 in male gender (OR 2.4). For TT [162 hematoma among 13,903 patients (1.2%)], the weighted points of VKA were 4 (OR 12.18), 1 in male gender (OR 1.89), and 1 for diabetes (OR 1.86). Other factors weighted 0 in both groups. A total score >1 was linked to a risk of hematoma > 1.3% for lobectomy or TT. AT should not be proposed to any patient under VKA, and in case of TT, to male patients with diabetes. Prospectively, patients had AT from May 2018 to February 2020, 529 patients underwent ambulatory TL (483) or TT (46) and only one patient experienced neck hematoma. CONCLUSION: We established a simple and reproducible predictive score of early discharge for lobectomy and TT that could be useful for patients' management.
BACKGROUND: The risk of postoperative compressive hematoma is the major limitation for a wide development of ambulatory thyroidectomy (AT). The aim of this study was to establish a risk score of hematoma on the basis of preoperative criteria. METHODS: All patients who underwent thyroidectomy between 2002 and 2017 were reviewed in a high-volume endocrine surgery center. Multivariate analysis of risk factors associated with hematoma was performed in lobectomy and total thyroidectomy (TT). We assigned the risk factors identified by multivariate analysis weighted points proportional to the regression coefficient values. A simple sum of all accumulated points for each patient calculated the total score. RESULTS: For lobectomy [31 hematoma among 3912 patients (0.8%)], the weighted points of Vit K antagonist (VKA) were 3 (OR 9.86), and 1 in male gender (OR 2.4). For TT [162 hematoma among 13,903 patients (1.2%)], the weighted points of VKA were 4 (OR 12.18), 1 in male gender (OR 1.89), and 1 for diabetes (OR 1.86). Other factors weighted 0 in both groups. A total score >1 was linked to a risk of hematoma > 1.3% for lobectomy or TT. AT should not be proposed to any patient under VKA, and in case of TT, to male patients with diabetes. Prospectively, patients had AT from May 2018 to February 2020, 529 patients underwent ambulatory TL (483) or TT (46) and only one patient experienced neck hematoma. CONCLUSION: We established a simple and reproducible predictive score of early discharge for lobectomy and TT that could be useful for patients' management.
Authors: F Pattou; F Combemale; S Fabre; B Carnaille; M Decoulx; J L Wemeau; A Racadot; C Proye Journal: World J Surg Date: 1998-07 Impact factor: 3.352
Authors: Andrew T Morrissey; Jason Chau; Warren K Yunker; Brad Mechor; Hadi Seikaly; Jeffrey R Harris Journal: J Otolaryngol Head Neck Surg Date: 2008-02