Suffocating neck hematoma in thyroidectomy: use of drains and perioperative risk factors in 1,334 surgeries

Purpose: A suffocating neck hematoma (SNH) is a rare but potentially fatal surgical complication of thyroidectomy.In an effort to reduce its incidence, many surgeons opt for the selective use of drains.However, there are no studies demonstrating the benefit of this strategy.Therefore, the use of drains remains controversial.Our primary outcome is to analyze the utility of drainage for SNH after thyroidectomies.Methods: A comparative retrospective study with a prospective case registry was conducted.All adult patients who underwent total-thyroidectomy or hemi-thyroidectomy from January 2014 to December 2023 in a high-volume center were included.Drains were placed selectively, based on the surgeon's decision.Demographic and perioperative variables were compared between patients who presented with SNH and those who did not and outcomes were compared between patients with or without drains.Results: A total of 1,334 surgeries were recorded during the study period.Three hundred thirty-eight patients (25.3%) had drains placed.Only 4 patients (0.3%) presented SNH, all from the drain group and all of whom required surgical reintervention.It was observed that only the presence of drains was statistically significantly associated with SNH (P = 0.004) and with reoperations (P = 0.004).No other perioperative factors were found to be statistically significantly related to SNH in our series.Conclusion: In our series, placement of drains after thyroidectomies did not prevent the development of SNH or its reoperation.No other perioperative variables were related to SNH.The selective use of drains after thyroidectomies has shown no clear benefit in our retrospective series.