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Predictive factors for intraoperative excessive bleeding in Graves' disease

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Title: Predictive factors for intraoperative excessive bleeding in Graves' disease
Authors: Yamanouchi, Kosho / Minami, Shigeki / Hayashida, Naomi / Sakimura, Chika / Kuroki, Tamotsu / Eguchi, Susumu
Issue Date: Jan-2015
Publisher: Elsevier Taiwan LLC
Citation: Asian Journal of Surgery, 38(1), pp.1-5; 2015
Abstract: Background: In Graves' disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to elucidate the predictive factors of the AIOBL. Methods: A total of 197 patients underwent thyroidectomy for G raves' disease between 2002 and 2012. We evaluated clinical factors that would be potentially related to AIOBL retrospectively. Results: The median period between disease onset and surgery was 16 months (range: 1-480 months). Conventional surgery was performed in 125 patients, whereas video-assisted surgery was performed in 72 patients. Subtotal and near-total/total thyroidectomies were performed in 137 patients and 60 patients, respectively. The median weight of the thyroid was 45 g (range: 7.3-480.0 g). Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p < 0.001). Additionally, AIOBL was correlated positively with the period between disease onset and surgery (p < 0.001) and negatively with preoperative free T4 (p < 0.01). Multivariate analysis showed that only the weight of the thyroid was independently correlated with AIOBL (p < 0.001). Four patients (2.0%) needed blood transfusion, including two requiring auto-transfusion, whose thyroids were all weighing in excess of 200 g. The amount of drainage during the initial 6 hours and days until drain removal was correlated positively with AIOBL (p < 0.001, each). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL. Conclusion: A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves' disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g.
Keywords: Graves' disease / Intraoperative blood loss / Thyroidectomy
URI: http://hdl.handle.net/10069/35388
ISSN: 10159584
DOI: 10.1016/j.asjsur.2014.04.007
Rights: © 2014, Asian Surgical Association. Published by Elsevier Taiwan LLC. / NOTICE: this is the author’s version of a work that was accepted for publication in Asian Journal of Surgery. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Asian Journal of Surgery, 38, 1, (2015)
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/35388

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