Association between neck hematoma and postoperative hypocalcemia: Analysis of 53,091 thyroidectomies from the American College of Surgeons-National Surgical Quality Improvement Program database.

Authors

Anastasios Karneris, Mason Forchetti, Nigel E Sim, Pinar J Smith, Sara Cohen, Sean M Wrenn, Vinod Narra, Theodoros Michelakos

Published in

Surgery. Pages 110604. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

Neck hematoma and hypocalcemia are among the most significant complications after thyroidectomy, but their relationship remains unclear. We hypothesized that post-thyroidectomy neck hematoma is associated with an increased risk of postoperative hypocalcemia. We aimed to test this hypothesis using a large national cohort and identify high-risk patients.
We performed a retrospective cohort analysis of thyroidectomy patients using the American College of Surgeons-National Surgical Quality Improvement Program database (2016-2023). The primary exposure was postoperative neck hematoma, and outcomes included multiple hypocalcemia metrics. Associations were evaluated using the χ² test or the Fisher exact test and multivariable logistic regression.
Among 53,091 thyroidectomy patients, most patients were female (76.8%) and White (70.2%), with a median age of 53 years (interquartile range, 40-64). Most cases were performed for a solitary nodule (N = 20,894, 40.6%). Postoperative hematoma complicated 916 (1.7%) cases, of which 223 (24.3%) were managed nonoperatively. The hematoma cohort exhibited a higher frequency of Graves' disease (10.2% vs 6.7%, P < .001). Hematoma patients had higher rates of all hypocalcemia metrics, including hypocalcemia before discharge (6.6% vs 3.7%, P < .001) and severe hypocalcemia events (5.2% vs 3.3%, P = .005). These associations persisted even for hematomas managed nonoperatively. Among nonreoperative open thyroidectomies without neck dissection (n = 22,157), similar results were observed: for example, hypocalcemia before discharge (6.0% vs 2.8%, P < .001) and severe hypocalcemia events (6.5% vs 2.8%, P < .001). Findings were more pronounced among Graves' disease patients (eg, intravenous calcium requirement 16.2% vs 5.8%, P < .001).
Post-thyroidectomy neck hematoma is associated with an increased risk of hypocalcemia-related complications even when managed nonoperatively. This suggests a possible pathophysiologic mechanism such as hematoma-induced parathyroid ischemia or venous congestion. Proactive calcium monitoring and supplementation are warranted in patients developing postoperative hematoma. Further studies are needed to elucidate the underlying pathophysiology.

PMID:
42791097
Bibliographic data and abstract were imported from PubMed on 26 Sep 2026.

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