Association between neck hematoma and postoperative hypocalcemia: Analysis of 53,091 thyroidectomies from the American College of Surgeons-National Surgical Quality Improvement Program database
In brief
After thyroidectomy, neck hematoma nearly doubles low calcium before discharge
In a national study of 53,091 thyroidectomies, 6.6% of patients with a postoperative neck hematoma had hypocalcemia before discharge, compared with 3.7% without one. The association remained when hematomas were treated without surgery, but the retrospective findings cannot establish cause; they support closer calcium monitoring and leave the underlying mechanism uncertain.
- Journal
- Surgery (Q1)
- Published
- 3 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Anastasios Karneris, Mason Forchetti, Nigel E Sim, Pinar J Smith, Sara Cohen, Sean M Wrenn, et al.
- PMID
- 42791097
- DOI
- 10.1016/j.surg.2026.110604
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 27 September 2026): Bone-modifying agents impact primary hyperparathyroidism surgery
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Abstract as published, via PubMed.
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