Alternative sources of cautery may improve post-operative hematoma rates but increase operative time in thyroid surgery

• Published in: Scientific reports Vol. 11; no. 1; p. 22569
• Main Authors: Best, Corliss A. E., Quimby, Alexandra E., Johnson-Obaseki, Stephanie
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 19.11.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/163/2743/1841; 692/700/565/545/546; Aged; Alternative energy sources; Cautery - adverse effects; Cautery - instrumentation; Cautery - methods; Databases, Factual; Female; Hematoma; Hematoma - etiology; Hematoma - prevention & control; Hemostatic Techniques - adverse effects; Hemostatic Techniques - instrumentation; Humanities and Social Sciences; Humans; Male; multidisciplinary; Operative Time; Protective Factors; Quality control; Retrospective Studies; Risk Assessment; Risk Factors; Science; Science (multidisciplinary); Statistical analysis; Surgery; Thyroid; Thyroid gland; Thyroidectomy; Thyroidectomy - adverse effects; Time Factors; Treatment Outcome; United States; United States
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-01953-5

A retrospective risk-adjusted analysis was completed using data from the National Surgical Quality Improvement Program (NSQIP) to (1) compare the risks of post-operative hematoma for thyroid surgery using conventional cautery compared alternative energy devices (defined as LigaSure and Harmonic Scalpel), and (2) compare operative times for the same. The primary outcome variable was post-operative hematoma occurrence. The secondary outcome variable was operative time. The exposure variable was use of conventional or alternative sources of cautery. All adult patients who underwent a total thyroidectomy, subtotal thyroidectomy or completion thyroidectomy between 2016 and 2018 were included. Multivariable linear and logistic regression analyses were performed to control for potentially confounding variables. A total of 13,330 cases were analyzed; 4342 used conventional cautery, and 8988 used alternative sources. There was a statistically significant decrease in post-operative hematoma risk using alternative sources of cautery compared to conventional cautery (OR 0.75; 95% CI 0.58–0.98) (p = 0.04). Use of alternative sources of cautery added 4.95 min onto operative time (95% CI 2.45–7.45) which was statistically significant (p < 0.0001). After controlling for confounding variables, there was a statistically significant lower rate of post-operative hematoma in thyroidectomies performed using alternative sources of cautery compared to those performed with traditional hemostatic methods. Alternative sources of cautery increased operative time by 4.95 min.