title: A multi-institutional international study of risk factors for hematoma after thyroidectomy.
abstract: BACKGROUND
  Cervical hematoma can be a potentially fatal complication after thyroidectomy, but its risk factors and timing remain poorly understood.
  
  
  METHODS
  We conducted a retrospective, case-control study identifying 207 patients from 15 institutions in 3 countries who developed a hematoma requiring return to the operating room (OR) after thyroidectomy.
  
  
  RESULTS
  Forty-seven percent of hematoma patients returned to the OR within 6 hours and 79% within 24 hours of their thyroidectomy. On univariate analysis, hematoma patients were older, more likely to be male, smokers, on active antiplatelet/anticoagulation medications, have Graves' disease, a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy, and benign pathology. Hematoma patients also had more blood loss, larger thyroids, lower temperatures, and higher blood pressures postoperatively. On multivariate analysis, independent associations with hematoma were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio, 2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio, 1.97), and increased thyroid mass (odds ratio, 1.01).
  
  
  CONCLUSIONS
  A significant number of patients with a postoperative hematoma present >6 hours after thyroidectomy. Hematoma is associated with patients who have a drain or hemostatic agent, have Graves' disease, are actively using antiplatelet/anticoagulation medications or have large thyroids. Surgeons should consider these factors when individualizing patient disposition after thyroidectomy.
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Campbell
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McCoy
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.forename: Carrie C
authors.initials: CC
authors.lastname: Lubitz
authors.forename: Jacob
authors.initials: J
authors.lastname: Moalem
authors.forename: Matthew
authors.initials: M
authors.lastname: Nehs
authors.forename: Tammy
authors.initials: T
authors.lastname: Holm
authors.forename: David Y
authors.initials: DY
authors.lastname: Greenblatt
authors.forename: Danielle
authors.initials: D
authors.lastname: Press
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Feng
authors.forename: Allan E
authors.initials: AE
authors.lastname: Siperstein
authors.forename: Elliot
authors.initials: E
authors.lastname: Mitmaker
authors.forename: Cassandre
authors.initials: C
authors.lastname: Benay
authors.forename: Roger
authors.initials: R
authors.lastname: Tabah
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.forename: Andrew
authors.initials: A
authors.lastname: Brekke
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.forename: Lutske
authors.initials: L
authors.lastname: Lodewijk
authors.forename: Antonia E
authors.initials: AE
authors.lastname: Stephen
authors.forename: Sapna
authors.initials: S
authors.lastname: Nagar
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
authors.forename: Maher
authors.initials: M
authors.lastname: Ghanem
authors.forename: Jason D
authors.initials: JD
authors.lastname: Prescott
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
authors.forename: Patricia
authors.initials: P
authors.lastname: Aragon Han
authors.forename: Cord
authors.initials: C
authors.lastname: Sturgeon
authors.forename: Dina M
authors.initials: DM
authors.lastname: Elaraj
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bayles
authors.forename: Rachel
authors.initials: R
authors.lastname: Heneghan
authors.forename: Peter
authors.initials: P
authors.lastname: Ochieng
authors.forename: Marlon A
authors.initials: MA
authors.lastname: Guerrero
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Ruan
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D016022:Case-Control Studies; D005260:Female; D006111:Graves Disease / Q000150:complications; D006406:Hematoma / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014481:United States