Graves' disease patients likely to encounter hematoma and hypocalcemia after thyroidectomy

The study is published in the Annals of Otology, Rhinology & Laryngology.

Sadaf Mohtashami and colleagues from the Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC, Canada carried out the present study to examine the association of Graves' disease with the development of postoperative neck hematoma.

A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program was formulated. 17 906 patients who underwent thyroidectomy were included.

Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves' disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury.

The following findings were seen-

2. One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves' disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves' disease for thyroidectomy.
3. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves' disease group and 1.9% (70/3621) in other patients.
4. The matched cohort showed that Graves' disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery.
5. There was no difference in recurrent laryngeal nerve injury among the 2 groups.

Hence, the authors concluded that "patients with Graves' disease undergoing thyroidectomy were more likely to have a postoperative neck hematoma and hypocalcemia compared to patients undergoing surgery for other indications. The results suggest that the primary indication for thyroid surgery has an impact on postoperative outcome. These findings may guide surgeons to preferentially monitor patients with Graves' disease undergoing thyroidectomy, particularly those with multiple risk factors."