Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Maroun, Christopher A.; Asmar, Margueritta El; Asmar, Marie Line El; Zhu, Guanghao; Gourin, Christine G.; Fakhry, Carole; Dhillon, Vaninder K.; Tufano, Ralph P.; Russell, Jonathon O.; Mandal, Rajarsi

doi:10.1002/lary.28269

Cited by 14 publications

(16 citation statements)

References 15 publications

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“…The difference in the rate of TT and CT between specialties may be attributable to variations in resident education and practice patterns. A NSQIP study showed that otolaryngologists were associated with a higher rate of drain placement in thyroidectomies relative to general surgeons; however, there was no significant difference in postoperative hematomas 32 . Another study determined that otolaryngologists in academic centers were more likely to use intraoperative nerve monitoring relative to general surgeons 33 .…”

Section: Discussionmentioning

confidence: 99%

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Brauer

Reddy

Burkey

et al. 2020

Otolaryngol.--head neck surg.

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Objective To characterize and assess the non–thyroid-specific postoperative complications of completion thyroidectomy as compared with total thyroidectomy. Study Design Retrospective analysis: 2005 to 2017. Setting National Surgical Quality Improvement Program database. Subjects and Methods Patients aged >18 years receiving a completion or total thyroidectomy were eligible for inclusion. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded. Results A total of 70,638 patients were analyzed, representing 64,763 total thyroidectomies and 5875 completion thyroidectomies. The 30-day mortality rate was 0.1% for both procedures ( P > .05). Overall, 1.7% and 1.4% of patients undergoing total and completion thyroidectomies experienced at least 1 complication ( P > .05), while 1.2% and 0.9% had a postoperative medical complication ( P = .0186), respectively. On multivariable analysis, patients undergoing total thyroidectomies were significantly more likely to return to the operating room (odds ratio [OR], 1.36; 95% CI, 1.04-1.80; P = .027) and to be readmitted (OR, 1.45; 95% CI, 1.16-1.81; P = .001). Adjusted analysis also demonstrated that patients undergoing total thyroidectomies were more likely to be inpatients (OR, 1.17; 95% CI, 1.11-1.24; P < .001), be treated by nonotolaryngologists (OR, 1.36; 95% CI, 1.29-1.45; P < .001), and smoke (OR, 1.22; 95% CI, 1.13-1.33; P < .001). Conclusion National data suggest that total and completion thyroidectomies are relatively safe procedures but that completion thyroidectomies are associated with lower rates of postoperative complications. These findings may play a role in determining treatment plans for patients and optimizing risk reduction.

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Section: Discussionmentioning

confidence: 99%

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Brauer

Reddy

Burkey

et al. 2020

Otolaryngol.--head neck surg.

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“…The drainage tube was found to be ineffective in preventing postoperative bleeding. Numerous studies, including a large-scale retrospective study ( 12 ), a randomized clinical trial ( 11 ), and meta-analysis ( 9 , 10 , 13 ), have proved drainage should not be routinely employed in COT. Drainage does not reduce the risk of complications like hemorrhage, recurrent laryngeal nerve palsy, and seroma, but increases the incidence of surgical site infection and hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Wang et al ( 14 ) and Chen et al ( 26 ) reported the drainage time with 2.7 ± 0.6 days and 4.3 ± 0.9 days, respectively, and the hospital stay with 6.4 ± 1.2 days and 6.4 ± 0.8 days, respectively. Previous studies revealed that drain placement is associated with more extended hospital stay in COT ( 9 – 12 ), and the application of negative pressure drainage is an important reason that interferes with lymph tube sealing and increases drainage volume ( 31 ). In the present study, with no drainage applied, the total hospital stay significantly reduced from 4.78 ± 1.33 days to 2.40 ± 0.71 days ( P < 0.001), and postoperative hospital stay decreased considerably from 2.15 ± 0.36 days to 2.04 ± 0.19 days ( P = 0.048).…”

Section: Discussionmentioning

confidence: 99%

“…However, an increasing number of patients complained about the inconvenience and surgical site pain caused by the drainage. Accumulating studies suggest that strict and effective intraoperative hemostasis is essential in preventing postoperative hemorrhage and that routine drainage tube insertion in COT is unnecessary (9)(10)(11)(12)(13). Furthermore, the use of drainage prolongs the hospital stay and increases the incidence of surgical site infection and hematoma (9,10,13).…”

Section: Introductionmentioning

confidence: 99%

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Drainage Tube Placement May Not Be Necessary During Endoscopic Thyroidectomy Bilateral Areola Approach: A Preliminary Report

Wang

Bai

et al. 2022

Front. Surg.

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BackgroundThe endoscopic thyroidectomy bilateral areola approach (ETBAA) improved cosmetic outcomes significantly and is now widely applied. The usage of drainage tubes is controversial in conventional open thyroidectomy (COT), but studies about drainage placement decisions during ETBAA are still limited. This study aimed to determine the feasibility of having no drainage tube applied during ETBAA on patients with papillary thyroid carcinoma.MethodsThe clinical data of patients undergoing ETBAA from July 2018 to May 2021 was retrospectively collected. The patients were divided into two groups based on drain placement: no-drain and drain. The two groups were matched at a ratio of 1:1. Fifty-five patients from each group were finally included. Postoperative complications and follow-up data were compared between the two groups.ResultsNo significant difference was observed between the two groups in the incidence of postoperative complications, including hemorrhage, surgical site infection, and subcutaneous seroma. Compared with the drain group, the operation time of the no-drain group was significantly shorter [(107.75 ± 24.59) min vs. (119.91 ± 34.05) min, P < 0.05]. The total and postoperative hospital stay was significantly shorter in the no-drain group [(2.40 ± 0.71) days vs. (4.78 ± 1.33) days, P < 0.001, (2.04 ± 0.19) days vs. (2.15 ± 0.36) days, P < 0.05], and the costs of surgical consumables were also significantly lower [(6,820.83 ± 164.29) CNY vs. (7,494.13 ± 216.7) CNY, P < 0.05]. The postoperative pain score of the no-drain group was significantly lower than the drain group [(1.58 ± 0.63) vs. (1.89 ± 0.76), P < 0.05].ConclusionsNo drainage applied during ETBAA on papillary thyroid carcinoma is safe and feasible. This practice does not increase the risk of postoperative complications, but it does shorten the operation time and hospital stay, as well as reduce medical costs. Furthermore, it alleviates the suffering of patients.

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“…29 A study by Maroun et al using ACS NSQIP data also demonstrated that drain use does not reduce hematoma risk and is associated with a longer LOS. 30 The differences in postoperative complications between the VSD and non-VSD groups may be attributable to the biomechanics of each method. VSDs that are used for thyroidectomies can be classified into advanced bipolar systems, such as LigaSure, or ultrasonic devices, such as the harmonic scalpel.…”

Section: Discussionmentioning

confidence: 99%

Vessel Sealant Devices in Thyroidectomies: An ACS-NSQIP Study

Németh¹,

Kong²,

Hwang³

et al. 2022

Southern Medical Journal

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Objectives: Thyroidectomies involve meticulous dissection of a highly vascularized organ and complications may develop, such as hematoma, hypocalcemia, and even hypoparathyroidism. Because some of these complications may be fatal, we sought to identify the differences in postthyroidectomy outcomes when the use of a vessel sealant device (VSD) such, as LigaSure or Harmonic scalpel, is compared with more traditional techniques, such as ligatures and clips. Methods:Using the 2016 American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database, we compared patients who underwent a thyroidectomy using a VSD with patients without a VSD for differences in postoperative complications.Results: A total of 5146 cases were identified and 3452 of those cases used a VSD, whose use was associated with significantly lower rates of hematoma, deep vein thrombosis, and hypocalcemia before discharge, as well as a shorter length of stay and longer operation time. Multivariate logistic regression showed that VSD was associated with 32.27% and 39.15% lower odds of hypocalcemia and hematoma, respectively. VSDs also were used more frequently in cases that had multinodular, severe, or substernal goiter or Graves disease as the primary indication for surgery and in patients with a higher body mass index. There was no significant difference in the incidence of recurrent laryngeal nerve injury between the two groups.Conclusions: Analysis of the American College of Surgeons National Surgical Quality Improvement Program data indicates that VSDs are associated with a lower risk of complications, such as hypocalcemia, hematoma, and deep vein thrombosis, suggesting that VSDs may be a more effective method of hemostasis than traditional techniques.

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Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Cited by 14 publications

References 15 publications

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Drainage Tube Placement May Not Be Necessary During Endoscopic Thyroidectomy Bilateral Areola Approach: A Preliminary Report

Vessel Sealant Devices in Thyroidectomies: An ACS-NSQIP Study

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