Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery

• Published in: Anaesthesia 2022-01, Vol.77 (1), p.82-95
• Main Authors: Iliff, H. A., El‐Boghdadly, K., Ahmad, I., Davis, J., Harris, A., Khan, S., Lan‐Pak‐Kee, V., O’Connor, J., Powell, L., Rees, G., Tatla, T. S.
• Format: Article
• Language: English
• Subjects: airway; Airway management; Airway Obstruction - etiology; Airway Obstruction - therapy; Cognition - physiology; Cognitive ability; Elective Surgical Procedures - adverse effects; emergency; Evacuation; Guidelines; haematoma; haemorrhage; Head and neck; Hematoma; Hematoma - diagnosis; Hematoma - etiology; Hematoma - therapy; Humans; Hyperbaric Oxygenation; Intubation; Intubation, Intratracheal; Multidisciplinary teams; Otolaryngology; Oxygenation; Patients; Respiratory tract; Surgery; Systematic review; Thyroid; Thyroid gland; Thyroid Gland - surgery; Thyroidectomy
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.15585

Summary Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri‐operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high‐quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post‐thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post‐haematoma evacuation care; day‐case thyroid surgery; training; consent and pre‐operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.