Background
Postoperative haematoma(PH) with resultant central neck compartment syndrome is the most devastating complication of thyroid surgery. Haemostatic agents(HA) (e.g.Floseal®) have been extensively used with the intention of securing robust haemostasis postoperatively. However, their effectiveness has not been clearly demonstrated to date.
Methods
A retrospective cohort study was performed from a prospective database in a head and neck tertiary centre. Comparative analysis was conducted to examine PH rates in two scenarios: 1)before and after the implementation of HA, and 2)between patients receiving HA versus those not. Secondary objectives included predictive analysis for PH.
Results
Data from 1751 thyroid operations was analysed. The PH rate post-introduction of HA use at our unit was three times higher than pre-introduction(2.1%vs0.7%,p=0.01). This was despite similar demographic and perioperative factors between groups such as operation type (e.g.lobectomy,total thyroidectomy), surgical dissection difficulty and anticoagulant use. There were no differences in PH rates between patients receiving HA and those not(p=0.46). However, HA were more likely to be administered in complex surgery despite all proxy measures of surgical complexity not accurately predicting PH in multivariate regression analysis.
Conclusions
HA were not shown to effectively prevent PH. Their routine use in thyroid surgery does not appear to be justified.
Rory O’Neill1, Alanna Quinn1, Patrick Sheahan1,2,
1 Department of Otolaryngology Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork
2 ENTO Research Unit, College of Medicine and Health, University College Cork, Cork