Risk Score of Neck Hematoma: How to Select Patients for Ambulatory Thyroid Surgery?
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ORIGINAL SCIENTIFIC REPORT
Risk Score of Neck Hematoma: How to Select Patients for Ambulatory Thyroid Surgery? Nathalie Chereau1,2 • Gaelle Godiris-Petit1 • Severine Noullet1 • Sophie Di Maria3 Sophie Tezenas du Montcel4 • Fabrice Menegaux1,2
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Accepted: 28 September 2020 Socie´te´ Internationale de Chirurgie 2020
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.
& Nathalie Chereau [email protected] 1
Department of Endocrine and Digestive Surgery, Hospital Pitie´ Salpeˆtrie`re, AP-HP, Sorbonne University, 47-83 Boulevard de l’Hoˆpital, 75013 Paris, France
2
Groupe de recherche clinique n: 16 Thyroid Tumors, Sorbonne University, Paris, France
3
Department of Anesthesiology, Hospital Pitie´ Salpeˆtrie`re, AP-HP, Sorbonne University, 75013 Paris, France
4
INSERM, Institut Pierre Louis d’Epidemiologie et de Sante´ Publique, Hospital Pitie´ Salpeˆtriere, APHP, Sorbonne University, 75013 Paris, France
123
World J Surg
Introduction Outpatient surgery is defined as same-day discharge from a surgical unit, not requiring an overnight hospital stay. However, patient comfort and safety are paramount after any kind of surgery. Thyroid surgery is theoretically a good candidate for outpatient surgery since it is not very painful. However, thyroid surgery carries some specific outcomes (nerve injury, hypocalcemia) and it exposes the patient to the risk of neck hematoma and airway compromise. Outpatient thyroidectomy has become increasingly popular [1], with several peer-reviewed reports of safe implementation [2,
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