Introduction Post-operative haemorrhage following thyroid and parathyroid surgery is a well-recognised life-threatening complication. Following an audit reporting a reoperation for bleeding rate of 1.3% in 1913 patients, a protocol driven approach including several specific measures at the time of wound closure (captured by the ‘ITSRED Fred’ mnemonic - Irrigation of wound, Time, Systolic blood pressure >100 mm Hg, Relief of neck extension, Elevation of venous pressure, Drain avoidance and Flap evaluation) was implemented and evaluated. Methods The records of 1525 thyroid and/or parathyroid surgical procedures in a single tertiary unit between 2017 and 2022 were reviewed following the implementation of the ‘ITSRED Fred’ protocol. The rates of re-bleeding requiring surgery and the management of patients requiring reoperation for bleeding were examined. Results The median age of the cohort was 53 years with a male: female ratio of 1:4. Of these, 946 (62%) had thyroid surgery, 541(35%) had parathyroid surgery and 38(2.5%) had both. Twelve (0.79%) patients had re-operation for bleeding (lower than previously reported). Of these, 4 (0.26%) required re-operation before leaving theatre; 6 (0.39%) had bleeding within 6 hours and two (0.13%) after 6 hours. Bleeding rates were 1.06% (n=10) in thyroid surgery (n=946) compared to 0.37% (n=2) in parathyroid surgery (n=541). Hospital stay was not increased for those needing re-operation for bleeding. Conclusions A protocol driven implementation of specific measures (such as the ‘ITSRED Fred’ protocol) may reduce the rate of re-operation for bleeding after thyroid and parathyroid surgery.
