Department of Endocrine and Digestive Surgery, Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Groupe de recherche clinique n: 16 Thyroid Tumors, Sorbonne University, Paris, France.
World J Surg. 2021 Feb;45(2):515-521. doi: 10.1007/s00268-020-05840-4. Epub 2020 Oct 30.
The risk of postoperative compressive hematoma is the major limitation for a wide development of ambulatory thyroidectomy (AT). The aim of this study was to establish a risk score of hematoma on the basis of preoperative criteria.
All patients who underwent thyroidectomy between 2002 and 2017 were reviewed in a high-volume endocrine surgery center. Multivariate analysis of risk factors associated with hematoma was performed in lobectomy and total thyroidectomy (TT). We assigned the risk factors identified by multivariate analysis weighted points proportional to the regression coefficient values. A simple sum of all accumulated points for each patient calculated the total score.
For lobectomy [31 hematoma among 3912 patients (0.8%)], the weighted points of Vit K antagonist (VKA) were 3 (OR 9.86), and 1 in male gender (OR 2.4). For TT [162 hematoma among 13,903 patients (1.2%)], the weighted points of VKA were 4 (OR 12.18), 1 in male gender (OR 1.89), and 1 for diabetes (OR 1.86). Other factors weighted 0 in both groups. A total score >1 was linked to a risk of hematoma > 1.3% for lobectomy or TT. AT should not be proposed to any patient under VKA, and in case of TT, to male patients with diabetes. Prospectively, patients had AT from May 2018 to February 2020, 529 patients underwent ambulatory TL (483) or TT (46) and only one patient experienced neck hematoma.
We established a simple and reproducible predictive score of early discharge for lobectomy and TT that could be useful for patients' management.
术后压迫性血肿的风险是广泛开展门诊甲状腺切除术（AT）的主要限制因素。本研究的目的是基于术前标准建立血肿风险评分。
在一个高容量内分泌手术中心回顾了 2002 年至 2017 年间接受甲状腺切除术的所有患者。在甲状腺叶切除术和全甲状腺切除术（TT）中对与血肿相关的危险因素进行多因素分析。我们将通过多因素分析确定的危险因素按与回归系数值成比例的权重分配点。每位患者所有累积点的简单总和计算总得分。
对于甲状腺叶切除术[3912 例患者中有 31 例血肿（0.8%）]，维生素 K 拮抗剂（VKA）的加权点为 3（OR 9.86），男性为 1（OR 2.4）。对于 TT[13903 例患者中有 162 例血肿（1.2%）]，VKA 的加权点为 4（OR 12.18），男性为 1（OR 1.89），糖尿病为 1（OR 1.86）。两组其他因素的加权均为 0。总分>1 与甲状腺叶切除术或 TT 的血肿风险>1.3%相关。任何正在服用 VKA 的患者均不应接受 AT，对于 TT，应避免患有糖尿病的男性患者接受 AT。前瞻性地，从 2018 年 5 月至 2020 年 2 月，有 529 例患者接受了门诊 TL（483 例）或 TT（46 例），仅 1 例患者出现颈部血肿。
我们建立了一个简单且可重复的甲状腺叶切除术和 TT 早期出院预测评分，可用于患者管理。
