Risk Factors for Post-Thyroidectomy Hemorrhage: A Systematic Review

Introduction: Post-thyroidectomy hemorrhage is a rare but serious complication that can lead to airway compromise and increased morbidity. Identifying the risk factors associated with postoperative bleeding is essential for optimizing patient selection, surgical techniques, and perioperative management. This systematic review aims to evaluate patient-related and surgical risk factors contributing to post-thyroidectomy hemorrhage.Materials and Methods: A comprehensive systematic review was conducted following PRISMA guidelines. Studies assessing risk factors for post-thyroidectomy hemorrhage were retrieved from PubMed, Scopus, Web of Science, and Embase. Inclusion criteria encompassed observational studies and randomized controlled trials investigating hemorrhage-related factors. Data extraction included demographic characteristics, comorbidities, surgical details, and bleeding incidence. Statistical analyses were performed to determine the odds ratios (ORs) for significant predictors.Results: A total of ۲۷ studies involving ۸,۴۵۲ patients were analyzed. Key risk factors for hemorrhage included age >۵۵ years (OR: ۲.۸۹, p<۰.۰۰۱), male sex (OR: ۱.۸۷, p=۰.۰۰۲), hypertension (OR: ۳.۲۱, p<۰.۰۰۱), diabetes (OR: ۲.۶۸, p<۰.۰۰۱), and anticoagulant use (OR: ۳.۰۲, p<۰.۰۰۱). Surgical factors, including total thyroidectomy (OR: ۲.۹۱, p<۰.۰۰۱), prolonged operative time >۱۲۰ minutes (OR: ۳.۷۵, p<۰.۰۰۱), and surgeon inexperience (<۱۰۰ cases, OR: ۴.۳۲, p<۰.۰۰۱), were strongly associated with increased bleeding risk.Conclusion: Post-thyroidectomy hemorrhage is influenced by both patient and surgical factors. Identifying high-risk individuals, optimizing perioperative care, and ensuring surgical expertise can significantly reduce complications. Future research should focus on predictive models and improved hemostatic strategies.

Keywords:

thyroidectomy , hemorrhage , risk factors , Postoperative complications