Haemostatic Agent Use and Associated Complications After Thyroid Surgery: A Retrospective Cohort Study in a Tertiary Head and Neck Centre

BACKGROUND: Haemostatic agents are increasingly used in thyroid surgery to improve operative outcomes. Although randomised controlled trials (RCTs) have demonstrated benefits, their real-world efficacy is under-researched. To assess whether these agents may facilitate day-case thyroidectomies in the UK, this study evaluated postoperative outcomes associated with intraoperative application of topical haemostatic agents. METHODS: A single-centre retrospective cohort study analysed patients aged ≥ 18 years who underwent elective thyroidectomies between May 2023 and May 2025. The primary outcome was the incidence of postoperative complications associated with intraoperative topical haemostatic agents, analysed using Fisher's exact test to compare patients who received haemostatic agents with those who did not. Secondary outcomes, including total drain output and length of inpatient stay, were analysed using the Mann-Whitney U test. RESULTS: In 167 thyroidectomies, haemostatic agents were used in 69 (41.3%) patients: oxidised regenerated cellulose in 41 operations (59.4%), fibrin sealants in 29 (42.0%), and both in one (1.6%). Overall, postoperative complications occurred in 37 (22%) patients. A significantly increased incidence of postoperative complications was observed with the use of haemostatic agents (p < 0.001; OR = 11.1; 95% CI, 2.69-50.5). No difference was observed in total drain output or length of stay between the two groups. CONCLUSION: In this cohort, postoperative complications were associated with the use of haemostatic agents, highlighting the challenge of observing RCT-demonstrated data in routine clinical practice. Further research with adjusted modelling is needed before determining the role of haemostatic agents in thyroid surgery. Until then, they cannot be relied upon to facilitate day-case thyroidectomies.