Impact of the Body Mass Index on Hemorrhage After Surgery for Thyroid Cancer
Authors Li P, Luo R, Guo L, Li W, Qi J
Received 19 November 2019
Accepted for publication 15 January 2020
Published 23 January 2020 Volume 2020:12 Pages 557—565
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Eileen O'Reilly
Peng Li,1 Ruihua Luo,1 Lanwei Guo,2 Wenlu Li,3 Jinxing Qi1
1Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 2Office for Cancer Control and Research, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 3Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
Correspondence: Peng Li
Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Jinshui District, Zhengzhou 450008, Henan, People’s Republic of China
Objective: To investigate the effects of different values of the body mass index (BMI) on postoperative hemorrhage (PH) in thyroid cancer (TC) and its clinical management.
Methods: This retrospective cohort study selected 43 patients with hemorrhage after TC surgery in 7413 cases. Patients were divided based on the BMI (kg/m2) into normal (24), overweight group (24 ≤BMl< 28) and obese (≥ 28) groups. Clinical and pathologic data, bleeding cause, bleeding site, treatment and prognosis were assessed.
Results: BMI (P=0.038) is an independent risk factor for PH of TC, related to hypertension (P=0.004) and coronary heart disease (P=0.001) in the three groups. Preoperative weight loss was not noted (P=0.477). Hemorrhage in 60.47% of patients occurred between 4 h and 8 h after surgery. The higher the BMI, the longer was the operative time (≥ 1 h, 65.12%) (P=0.017), which resulted in greater intraoperative blood loss (≥ 20 mL, 74.42%) (P=0.025), postoperative hypoparathyroidism (P=0.015) and the probability of injury to the recurrent laryngeal nerve (P=0.026). The main causes of bleeding were incomplete vascular ligation (30.23%), severe postoperative cervical activity (16.28%) and long-term use of anticoagulant drugs (11.63%). Overall survival at 5 years in the obese group was poor (P=0.015). Forty patients (93.02%) underwent surgical exploration and hemostasis and two patients (4.65%) underwent tracheotomy. All PH complications disappeared completely after active postoperative treatment, and all patients were discharged from hospital.
Conclusion: Obesity is closely associated with PH in TC patients. Therefore, in obese patients, active prevention preoperatively, complete hemostasis intraoperatively, early detection and timely treatment postoperatively are the key factors to reduce PH risk.
Keywords: body mass index, thyroid cancer, hemorrhage
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