Department of Surgery, Salford Royal Hospital, Salford, UK.
Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Br J Surg. 2021 Jul 23;108(7):851-857. doi: 10.1093/bjs/znab015.
Post-thyroidectomy haemorrhage occurs in 1-2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation.
The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018.
Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality.
The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.
甲状腺切除术后出血的发生率为 1-2%，其中四分之一需要床边血块清除。由于有发生危及生命的出血的风险，因此之前英国内分泌和甲状腺外科医师协会（BAETS）的指南规定不支持日间甲状腺切除术。本研究旨在回顾目前英国最佳数据，以评估这一建议的最新变化。
对英国内分泌和甲状腺外科手术登记处进行分析，以确定 2004 年至 2018 年甲状腺切除术后出血的发生率和危险因素。
所有甲状腺切除术患者中有 1.2%（449/39014）因出血而行再次手术。多变量分析显示，男性、年龄增加、再次手术、胸骨后甲状腺肿和全甲状腺切除术与再次手术出血风险增加显著相关，而外科医生每月甲状腺切除术的数量与出血风险降低相关。从这些预测因子估计出血风险的变化得到的伪 R2 值较低，表明出血是不可预测的。半甲状腺切除术患者中有 0.9%（217/24700）因出血而行再次手术，男性、年龄增加、外科医生数量减少和再次手术是危险因素。甲状腺切除术后的死亡率为 0.1%（23/38740）。在包括再次手术治疗出血的淋巴结清扫术和年龄的多变量模型中，这些因素是死亡的显著危险因素。
男性行全甲状腺切除术出血风险最高，但总体出血不可预测。半甲状腺切除术时，外科医生甲状腺切除术的数量增加可降低出血风险。这项分析支持英国内分泌和甲状腺外科医师协会的修订建议，即限制日间甲状腺手术仅用于由高容量外科医生进行的半甲状腺切除术，对老年人、男性、胸骨后甲状腺肿患者和再次手术患者需谨慎。
