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Study Highlights Need to Identify Blood Transfusion Risk Factors in Patients Receiving Thyroidectomy

by Linda Kossoff •

What can be learned about the incidence, risk factors, and complications of blood transfusions (BTs) in patients who undergo elective thyroidectomy?

BOTTOM LINE

Recognition of BT risk factors is imperative to identify at-risk patients who choose to undergo thyroidectomy and to reduce transfusions by controlling modifiable risk factors.

BACKGROUND: Thyroidectomy is an increasingly common procedure whose complications may include bleeding, hematomas, and thyroid storm. Blood transfusion is a recognized independent risk factor for postoperative complications, and some patient-level characteristics contribute to increased BT risk. There is a paucity of data on risks and outcomes of BT in thyroidectomy patients.

STUDY DESIGN: Retrospective cohort study.

SETTING: Medical College, Aga Khan University, Karachi, Pakistan.

SYNOPSIS: Researchers mined data from the American College of Surgeons National Surgical Quality Improvement Program to identify 180,483 adult patients who underwent partial, subtotal/total, or completion thyroidectomy for any indication between Jan. 1, 2005, and Dec. 31, 2019. Sociodemographic characteristics, including body mass index (BMI) and American Society of Anesthesiology (ASA) physical status were extracted. Medical comorbidities were noted, as were surgical indication, operative time, and wound classification. Intraoperative or postoperative BT was the primary outcome. Patients were subdivided into BT (237 patients, mean age 61 years) and non-BT (180,136 patients, mean age 52 years) groups. Findings showed that BT risk factors included underweight BMI, bleeding disorders, anemia, preoperative transfusion, ASA 3–5, operative time >150 minutes, and inpatient thyroidectomy. Moreover, BT among thyroidectomy patients independently predicted nearly all complications studied, including pulmonary, cardiac, and infectious complications, and postoperative mortality. The authors state that the results underscore the need for preventing BT in thyroidectomy patients. Study limitations included the likelihood of additional BT-associated factors that could not be assessed due to the large database.

CITATION: Waqar U, Tariq J, Chaudhry AA, et al. A comprehensive assessment of blood transfusions in elective thyroidectomy based on 180,483 patients. Laryngoscope. 2022;132:2078–2084.