Risk factors for post-thyroidectomy haemorrhage: a meta-analysis.
BACKGROUND
Post-thyroidectomy haemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. In this study, we analysed the potential risk factors for the occurrence of post-thyroidectomy haemorrhage.


METHODS
The PubMed and SCIE databases were comprehensively searched for studies published before June 30, 2016. Studies on patients who underwent an open thyroidectomy with or without neck dissection were included, and RevMan 5.3 software was used to analyse the data.


RESULTS
Twenty-five studies and 424 563 patients were included in this meta-analysis, and post-thyroidectomy haemorrhage occurred in 6277 patients (incidence rate = 1.48%). The following variables were associated with an increased risk of post-thyroidectomy haemorrhage: older age (MD = 4.30, 95% CI = 3.09-5.52,P< 0.00001), male sex (OR = 1.73, 95% CI = 1.54-1.94,P< 0.00001), Graves' disease (OR = 1.76, 95% CI = 1.44-2.15,P< 0.00001), antithrombotic agents use (OR = 1.96, 95% CI 1.55-2.49,P< 0.00001), bilateral operation (OR = 1.71, 95% CI = 1.50-1.96,P< 0.00001), neck dissection (OR = 1.53, 95% CI = 1.11-2.11,P= 0.01) and previous thyroid surgery (OR = 1.62, 95% CI = 1.12-2.34,P= 0.01). Malignant tumours (OR = 1.07, 95% CI = 0.89-1.28,P= 0.46) and drainage device use (OR = 1.27, 95% CI = 0.74-2.18,P= 0.4) were not associated with post-thyroidectomy haemorrhage.


CONCLUSIONS
Our systematic review identified a number of risk factors for post-thyroidectomy haemorrhage, including older age, male sex, Graves' disease, antithrombotic agents use, bilateral operation, neck dissection and previous thyroid surgery. Early control of modifiable risk factors could improve patient outcomes and satisfaction.
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Jinhao
J
Liu
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Wei
W
Sun
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Wenwu
W
Dong
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Zhihong
Z
Wang
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Ping
P
Zhang
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Ting
T
Zhang
Department of Thyroid SurgeryThe First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
Hao
H
Zhang
D000367:Age Factors; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D008297:Male; D037981:Neck Dissection; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods
D005343:Fibrinolytic Agents