Best Corliss A E, Quimby Alexandra E, Johnson-Obaseki Stephanie
The Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
Sci Rep. 2021 Nov 19;11(1):22569. 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.
利用国家外科质量改进计划（NSQIP）的数据完成了一项回顾性风险调整分析，以（1）比较使用传统电灼法与替代能量设备（定义为LigaSure和超声刀）进行甲状腺手术的术后血肿风险，以及（2）比较二者的手术时间。主要结局变量是术后血肿的发生情况。次要结局变量是手术时间。暴露变量是传统或替代电灼源的使用情况。纳入了2016年至2018年间接受全甲状腺切除术、次全甲状腺切除术或甲状腺切除术后再手术的所有成年患者。进行多变量线性和逻辑回归分析以控制潜在的混杂变量。共分析了13330例病例；4342例使用传统电灼法，8988例使用替代电灼源。与传统电灼法相比，使用替代电灼源术后血肿风险有统计学意义的降低（比值比0.75；95%置信区间0.58 - 0.98）（p = 0.04）。使用替代电灼源使手术时间增加了4.95分钟（95%置信区间2.45 - 7.45），具有统计学意义（p < 0.0001）。在控制混杂变量后，与使用传统止血方法的甲状腺切除术相比，使用替代电灼源进行的甲状腺切除术术后血肿发生率在统计学上显著更低。替代电灼源使手术时间增加了4.95分钟。
