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Energy vessel sealant devices are associated with decreased risk of neck hematoma after thyroid surgery

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Abstract

Postoperative neck hematomas following thyroidectomy occur in up to 6.5% of cases. It is unclear whether the use of energy vessel sealant devices effects the rate of PNH. We hypothesized use of an EVSD to be associated with decreased risk of PNH in patients undergoing thyroidectomy. The 2016–2017 American College of Surgeons Thyroidectomy database was queried for patients undergoing thyroidectomy with and without EVSDs. A multivariable logistic regression analysis was performed to evaluate for risk of PNH. From 11,355 patients undergoing thyroidectomy, an EVSD was used for 7460 (65.7%) patients. Age distribution was similar between the two groups (52 vs. 53-years old, p = 0.467). Compared to patients without EVSD used, patients with EVSD used had higher rates of comorbid hypertension (40.6% vs. 34.8%, p < 0.001) and diabetes (14.2% vs. 11.5%, p < 0.001); however, a lower rate of PNH (1.4% vs. 2.4%, p < 0.001). After adjusting for known risk factors for PNH including age, prior neck surgery, and comorbidities, EVSD use was associated with a decreased risk of PNH (OR 0.453, 95% CI 0.330–0.620, p < 0.001). The strongest associated risk factors for PNH were hypertension (OR 1.823, 95% CI 1.283–2.591, p = 0.001) and toxic goiter (OR 1.837, 95% CI 1.144–2.949, p = 0.012). When compared to standard vessel ligation, EVSD use was associated with a lower risk of PNH in patients undergoing thyroidectomy. The strongest associated risk factor for PNH was toxic goiter. Future prospective research is needed to confirm these findings and if corroborated, then increased use of an EVSD should be employed.

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Authors and Affiliations

  1. Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA

    Katherine Moran, Areg Grigorian, Dawn Elfenbein, Sebastian Schubl, Zeljka Jutric, Michael Lekawa & Jeffry Nahmias

  2. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Dawn Elfenbein

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  1. Katherine Moran
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  2. Areg Grigorian
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This research involved humans. However, since this retrospective study was performed using a national database with deidentified patients, risk to participants is minimal.

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American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Moran, K., Grigorian, A., Elfenbein, D. et al. Energy vessel sealant devices are associated with decreased risk of neck hematoma after thyroid surgery. Updates Surg 72, 1135–1141 (2020). https://doi.org/10.1007/s13304-020-00776-9

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