World Journal of Surgery

, Volume 38, Issue 6, pp 1262–1267 | Cite as

A Novel Method for the Management of Post-Thyroidectomy or Parathyroidectomy Hematoma: A Single-Institution Experience after over 4,000 Central Neck Operations

  • Jennifer L. Dixon
  • Samuel K. SnyderEmail author
  • Terry C. Lairmore
  • Daniel Jupiter
  • Cara Govednik
  • John C. Hendricks



Cervical hematoma is a rare but serious complication of thyroid and parathyroid surgery that has historically required inpatient monitoring. With improved surgical technique and experience, operations are being performed increasingly as outpatient procedures. Therefore, a safe and systematic approach to cervical exploration of a postoperative hematoma needs to be defined.


From 1996 to 2013, a retrospective review was performed of 4,140 thyroid and parathyroid operations. Surgical outcomes data were recorded, specifically including the occurrence of a cervical hematoma, time interval to presentation, and methods of management.


A total of 18 patients (0.43 %) developed a postoperative cervical hematoma that required surgical intervention. The occurrence of hematoma was 0.66 % (n = 11) for bilateral thyroid procedures, 0.21 % (n = 3) for unilateral thyroid procedures, and 0.13 % (n = 1) for parathyroid procedures. There were 3 (1.69 %) patients who had combined unilateral thyroid and parathyroid procedures and developed hematomas. Emergent bedside decompression was required for only two patients, both of whom suffered respiratory arrest in the postoperative anesthesia recovery unit. The remaining 16 patients were explored in the operating room, utilizing initial local anesthesia in the semi-upright position in 11 patients (69 %).


From our experience, hematomas that caused significant airway compromise leading to respiratory arrest occurred in the postoperative anesthesia recovery room, and hematoma presentation after this time did not require emergent bedside decompression. Hematoma, when it occurs, can otherwise be managed safely in the operating room after inpatient or outpatient procedures using initial local anesthesia with the patient in the semi-upright position for hematoma evacuation.


Recurrent Laryngeal Nerve Respiratory Arrest Central Neck Postoperative Hematoma Strap Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Snyder SK, Hamid KS, Roberson CR et al (2010) Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg 210:575–582PubMedCrossRefGoogle Scholar
  2. 2.
    Burkey SH, van Heerden JA, Thompson GB et al (2001) Reexploration for symptomatic hematomas after cervical exploration. Surgery 130:914–920PubMedCrossRefGoogle Scholar
  3. 3.
    Doran HE, England J, Palazzo F (2012) Questionable safety of thyroid surgery with same day discharge. Ann R Coll Surg Engl 94:543–547PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Rosenbaum MA, Haridas M, McHenry CR (2008) Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 195:339–343PubMedCrossRefGoogle Scholar
  5. 5.
    Promberger R, Ott J, Kober F et al (2012) Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 99:373–379PubMedCrossRefGoogle Scholar
  6. 6.
    Lang BH, Yih PC, Lo CY (2012) A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe? World J Surg 36:2497–2502. doi: 10.1007/s00268-012-1682-1 PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393:667–673PubMedCrossRefGoogle Scholar
  8. 8.
    Materazzi G, Dionigi G, Berti P et al (2007) One-day thyroid surgery: retrospective analysis of safety and patient satisfaction on a consecutive series of 1,571 cases over a 3-year period. Eur Surg Res 39:182–188PubMedCrossRefGoogle Scholar
  9. 9.
    Bergamaschi R, Becouarn G, Ronceray J et al (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75PubMedCrossRefGoogle Scholar
  10. 10.
    Rios-Zambudio A, Rodriguez J, Riquelme J et al (2004) Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 240:18–25CrossRefGoogle Scholar
  11. 11.
    Terris D, Snyder S, Carneiro-Plus D et al (2013) American Thyroid Association statement on outpatient thyroidectomy. Thyroid 23:1193–1202PubMedCrossRefGoogle Scholar
  12. 12.
    Shaha AR, Jaffe BM (1994) Practical management of post-thyroidectomy hematoma. J Surg Oncol 57:235–238PubMedCrossRefGoogle Scholar
  13. 13.
    Leyre P, Desurmont T, Lacoste L et al (2008) Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery? Langenbecks Arch Surg 393:733–737PubMedCrossRefGoogle Scholar
  14. 14.
    Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24:971–975. doi: 10.1007/s002680010160 PubMedCrossRefGoogle Scholar
  15. 15.
    Shandilya M, Kieran S, Walshe P et al (2006) Cervical haematoma after thyroid surgery: management and prevention. Ir Med J 99:266–268PubMedGoogle Scholar
  16. 16.
    Chang LY, O’Neill C, Suliburk J et al (2011) Sutureless total thyroidectomy: a safe and cost-effective alternative. ANZ J Surg 81:510–514PubMedCrossRefGoogle Scholar
  17. 17.
    Bononi M, Amore Bonapasta S, Vari A et al (2010) Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 32:1173–1177PubMedCrossRefGoogle Scholar
  18. 18.
    Mirnezami R, Sahai A, Symes A et al (2007) Day-case and short-stay surgery; the future for thyroidectomy? Int J Clin Pract 61:216–222CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Jennifer L. Dixon
    • 1
  • Samuel K. Snyder
    • 1
    Email author
  • Terry C. Lairmore
    • 1
  • Daniel Jupiter
    • 1
  • Cara Govednik
    • 1
  • John C. Hendricks
    • 1
  1. 1.Department of SurgeryScott & White Memorial HospitalTempleUSA

Personalised recommendations