Efficacy of four different hemostatic agents in thyroid surgery in reducing the amount of post-operative fluid collection

Abstract

Purposes: Postoperative bleeding remains a life-threatening complication in thyroid surgery. The aim was to assess the efficacy of four different hemostatic agents, Collagen-Fibrinogen-Thrombin Patch (CFTP) in two sizes (3 × 2.5 cm and 9.5 × 4.8 cm), polysaccharide particles (1 g) and Cellulose Gauze (2.5 × 5 cm) on postoperative drainage volume (DV) compared to a control group.

Methods: We included from October 2007 until Mai 2011, 150 patients (30 per group) for this monocentric, retrospective case-controlled study. Patients were scheduled for a hemithyroidectomy or thyroidectomy. The primary endpoint was the postoperative DV within the first 24 h, secondary the incidence of adverse events.

Results: There were no difference in demographic parameters. The mean DV (± SD) was 51.15 (± 36.86) ml in the control, 50.65 (± 42.79) ml in small (3 × 2.5 cm), 25.38 (± 23.99) ml in large CFTP (9.5 × 4.8 cm), 53.11 (± 39.48) ml in the polysaccharide particles and 48.94 (± 30.59) ml in the cellulose gauze group. DV was significantly reduced with the large CFTP (p < 0.05) compared to all other groups. There were no adverse events.

Conclusions: We were able to demonstrate a significant reduction in the DV for the large CFTP group compared to the other collectives. Although this as being associated with not inconsiderable costs and we would only recommend its use for high-risk patients only.

Keywords: Drainage volume; Hemostatic agents; Postoperative bleeding; Thyroid surgery.

Fig. 1

Flowchart of the trail design (CFTP = Collagen-Fibrinogen-Thrombin Patch)

Fig. 2

Comparison of different local hemostatic agents (CFTP = Collagen-Fibrinogen-Thrombin Patch, MRSA = Methicillin-resistant Staphylococcus aureus, MRSE = Methicillin-resistant Staphylococcus epidermidis, VRE = Vancomycin-resistant Enterococcus) [8, 17, 19, 20, 21, 22, 23]

Fig. 3

A Mean values and SD in drain volumes 24 h. after surgery for all groups, group 1 surgical hemostasis, group 2 surgical hemostasis and CFTP (CFTP = Collagen-Fibrinogen-Thrombin Patch) (3 × 2.5 cm), group 3 surgical hemostasis and CFTP (9.5 × 4.8 cm), group 4 surgical hemostasis and polysaccharide particles (1 g), group 5 surgical hemostasis and oxidized regenerated cellulose gauze. B Mean drainage volume 24 h after surgery, All groups differ significantly from group 3 CFTP (9.5 × 4.8 cm)* (CFTP = Collagen-Fibrinogen-Thrombin Patch)