title: Relationship between postoperative venous thromboembolism and hemorrhage in patients undergoing total thyroidectomy without preoperative prophylaxis.
abstract: BACKGROUND
  The aim of the present study was to critically review the incidence of venous thromboembolism and postoperative hemorrhage in patients undergoing total thyroidectomy without preoperative prophylaxis.
  
  
  METHODS
  A prospective electronic database of all patients undergoing total thyroidectomy over a six-year period within August 2013 in our medical unit was analyzed. The incidence of postoperative bleeding and Venous thromboembolism (VTE) was reviewed by subgrouping all patients according to a risk factor score (RFS) for VTE as outlined in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Best Practice Guidelines.
  
  
  RESULTS
  An overall 1018 consecutive patients [244 men (24%, mean age 46 ± 13 years), 778 women (76%, mean age 44 ± 17 years)] underwent total thyroidectomy. Postoperative bleeding occurred in 8/1018 patients (0.8%). One out of 1018 (0.1%) patients also subcategorized according to the RFS had VTE. The incidence of VTE complication in the entire population was lower than the risk of postoperative bleeding (P < .0001).
  
  
  CONCLUSIONS
  The risk of developing VTE in patients who undergo total thyroidectomy for benign and malignant diseases without preoperative prophylaxis is roughly 8-fold less than developing a potentially life threatening complication as postoperative bleeding. Until large well conducted prospective studies on the impact of preoperative prophylaxis on postoperative VTE and bleeding will clarify the issue, it is conceivable to propose the use of stockings and/or anticoagulants according to the individual patient risk factors.
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy. Electronic address: paolo.limongelli@unina2.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Adelmo
authors.initials: A
authors.lastname: Gubitosi
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: del Genio
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Casalino
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Amoroso
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Jannelli
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.affiliation: Department of General Surgery, Second University of Naples, Via Gino Doria 78, 80128 Naples, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology