Reducing the risk of significant bleeding after thyroid and parathyroid surgery: the role of a protocol driven approach

Abstract Objective Post-operative haemorrhage following thyroid and parathyroid surgery is a rare but life-threatening complication. A structured protocol (“ITSRED Fred” mnemonic: Irrigation, Time, Systolic BP greater than 100 mmHg, Relief of neck extension, Elevation of venous pressure, Drain avoidance, Flap evaluation) was introduced to standardise haemostasis and closure. Methods Records of 1525 thyroid and parathyroid operations over a five-year period at a tertiary unit were reviewed following protocol implementation. Re-operation for bleeding and management outcomes were analysed. Results Twelve patients (0.79 per cent) required re-operation for bleeding, lower than the previous 1.3 per cent. Bleeding occurred intra-operatively ( n = 4), within 6 hours ( n = 6) and after 6 hours ( n = 2). Thyroid surgery had a higher bleeding rate (1.06 per cent) than parathyroid surgery (0.37 per cent). Hospital stay was unaffected. Conclusion The ITSRED Fred protocol was associated with reduced re-bleeding rates. Beyond safety, its structured format provides a reproducible training tool to teach junior surgeons systematic haemostatic assessment at closure.