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Original Investigation
September 18, 2019

Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations

Author Affiliations
  • 1Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 3Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
  • 5Department of Otolaryngology–Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
  • 6Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 7Department of Otolaryngology–Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
  • 8Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
JAMA Surg. Published online September 18, 2019. doi:10.1001/jamasurg.2019.3146
Key Points

Question  Do rates of postoperative neck hematoma differ between thyroid operations using vessel-sealant devices and those using conventional hemostasis?

Findings  In this cohort study of 6522 propensity score–matched patients undergoing thyroid operations with vessel-sealant devices or by conventional hemostasis, those undergoing operations with the conventional approach had increased odds of developing a postoperative neck hematoma and increased length of hospital stay, but there was no difference in the rate of recurrent laryngeal nerve injury.

Meaning  The results suggest that postoperative neck hematoma outcomes after thyroid surgery may differ based on hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.

Abstract

Importance  Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied.

Objective  To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma.

Design, Setting, and Participants  This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure–Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups.

Main Outcomes and Measures  The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay.

Results  One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24).

Conclusions and Relevance  Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.

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