A large single-center analysis of postoperative hemorrhage in more than 43,000 thyroid operations: The relevance of intraoperative systolic blood pressure, the individual surgeon, and surgeon-to-patient gender (in-)congruence

Abstract

Background

To date, there is no reliable measure for the prevention of postoperative hemorrhage after thyroid surgery. An increase in the postoperative hemorrhage rate at our institution in 2021 prompted us to look for possible causes with a special focus on perioperative systolic blood pressure, the individual surgeon, and surgeon-to-patient gender congruence.

Methods

We drew on our prospectively managed database to review 43,360 consecutive thyroid surgeries. In addition to a risk factor analysis, a subanalysis of perioperative systolic blood pressure values was performed in 26 patients with postoperative hemorrhage and 26 controls, on the basis of the hypothesis that a targeted pharmacologic increase in systolic blood pressure could reveal covert sources of bleeding.

Results

Postoperative hemorrhage developed in 707 of 43,360 cases (1.6%). Risk factors included older age (odds ratio, 1.017), male gender (odds ratio, 1.629), Graves disease (odds ratio, 1.515), and recurrent benign thyroid disease (odds ratio, 1.693). The individual surgeon significantly influenced the rate of postoperative hemorrhage (odds ratio, up to 2.817). Surgeon-to-patient gender (in)congruence did not affect the rate of postoperative hemorrhage. The subanalysis of perioperative blood pressure revealed mostly arterial bleeding sources (17/26 [65.4%]) and significantly lower intraoperative yet greater postoperative systolic blood pressure values (100 mm Hg vs median 120 mm Hg; P = .009; and 150 mm Hg vs 130 mm Hg; P = .005; respectively) in patients who later developed postoperative hemorrhage.

Conclusion

Although our data suggest that increasing intraoperative systolic blood pressure before wound closure may help to detect covert bleeding sources and therefore prevent postoperative hemorrhage, future studies are necessary to substantiate this finding. We recommend close collaboration with anesthesiologists as well as counteracting postoperative blood pressure increases. The individual surgeon was a major factor influencing the rate of postoperative hemorrhage. However, there were no differences between female and male surgeons operating on female or male patients.