Factors Increasing the Likelihood of Postoperative Hematomas Following Thyroid Surgery.

Abstract

Neck hematoma following thyroid surgery is a potentially life-threatening complication. This retrospective case-control study reviewed neck hematoma reoperations following thyroid surgery (2009-2024), using 3:1 matching. Univariable analysis identified hematoma and delayed onset (≥ 6 h) risk factors, with odds ratios (ORs) and 95% confidence intervals (CIs). Among 5502 surgeries, the hematoma incidence was 0.55% (n = 30). The mean age was 54 and the female-to-male ratio was 7:3. Key risk factors included pre-induction blood pressure > 160 mmHg (OR = 3.04 [95% CI = 1.25-7.39], p = 0.014) and limited blood pressure change postmedication (OR = 6.25 [95% CI = 1.03-38.08], p = 0.047). The hematoma group had higher rates of smoking, hypertension, diabetes, Graves' disease, and prior thyroid surgery, and, in delayed hematoma cases, larger nodules, total thyroidectomy, and central neck dissection, though not statistically significant. Patients with poorly controlled blood pressure may not be candidates for outpatient thyroidectomy.