Network meta‐analysis of topical haemostatic agents in thyroid surgery

Background The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy. Methods A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using ei...

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Bibliographic Details
Published in:British journal of surgery 2018-11, Vol.105 (12), p.1573-1582
Main Authors: Polychronidis, G., Hüttner, F. J., Contin, P., Goossen, K., Uhlmann, L., Heidmann, M., Knebel, P., Diener, M. K., Büchler, M. W., Probst, P.
Format: Article
Language:English
Subjects:
Administration, Topical
Adult
Cervical Vertebrae
Hematoma - etiology
Hematoma - surgery
Hemostatics - administration & dosage
Humans
Length of Stay - statistics & numerical data
Meta-analysis
Network Meta-Analysis
Operative Time
Postoperative Hemorrhage - prevention & control
Randomized Controlled Trials as Topic
Reoperation - statistics & numerical data
Surgical outcomes
Thyroid gland
Thyroidectomy - adverse effects
Treatment Failure
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Summary:Background The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy. Methods A systematic literature search was performed, and RCTs involving adult patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random‐effects model was used for network meta‐analysis with minimally informative prior distributions. Results Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds ratio (OR) 1·53, 95 per cent credibility interval 0·21 to 10·77); PHA versus control (OR 2·74, 0·41 to 16·62) and AHA versus PHA (OR 1·77, 0·12 to 25·06). No difference was observed in the time required for drain removal, duration of hospital stay, and the rate of postoperative hypocalcaemia or recurrent nerve palsy. AHA led to a significantly lower total postoperative blood loss and reduced operating time in comparison with both the control and PHA groups. Conclusion The general use of local haemostatic agents has not been shown to reduce the rate of clinically relevant bleeding. Little value
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.10975