Perioperative risk factors for post-thyroidectomy hematoma: Significance of pain and ketorolac usage

Head Neck. 2019 Oct;41(10):3656-3660. doi: 10.1002/hed.25895. Epub 2019 Aug 7.

Abstract

Background: Post-thyroidectomy hematoma (PH) is uncommon but may be a life-threatening complication. We explored perioperative risk factors for PH, with emphasis on perioperative hemodynamics, pain, and medications.

Methods: A retrospective case-control study was performed with matching for age, sex, and type of operation. Univariate and multivariate analyses were performed to identify independent risk factors.

Results: In 1780 thyroid surgeries, 22 cases of PH were detected (1.24%). Antithrombotic agent usage, numeric rating scale (NRS) of postoperative pain, and two or more doses of ketorolac postoperatively significantly differed between the two groups. Multiple regression analysis revealed all three variables were significant risk factors for PH (odds ratio = 55.23, 10.48, and 22.58, respectively). Perioperative hemodynamics did not affect PH.

Conclusions: Antithrombotic agent usage, postoperative pain, and two or more doses of ketorolac postoperatively were identified as independent risk factors for PH. Proper pain control and judicious usage of ketorolac are recommended.

Keywords: hematoma; ketorolac; pain; risk factor; thyroidectomy.

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Hematoma / etiology*
  • Hematoma / physiopathology
  • Humans
  • Incidence
  • Ketorolac / adverse effects*
  • Ketorolac / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pain Management
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / physiopathology
  • Perioperative Care
  • Postoperative Complications / drug therapy*
  • Postoperative Complications / etiology
  • Reference Values
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Thyroidectomy / adverse effects*
  • Thyroidectomy / methods
  • Treatment Outcome

Substances

  • Ketorolac