The impact of 4DryField PH on hemostasis and postoperative drain placement in thyroid surgery

Thyroid surgery carries a risk of postoperative hematoma due to rich vascularity, commonly managed by drain placement, potentially increasing hospital stay. 4DryField PH (4DF), a powdered hemostatic material, has been widely used in surgery to improve hemostasis. This study investigates the impact of using 4DF in thyroid surgery on postoperative drainage placement.

This retrospective study analyzed 208 patients undergoing neuro-monitored and Ligasure-assisted thyroidectomy. Patients were divided into non-hemostatic material and drain (NHM, n = 107), and 4DF groups (n = 101). In the 4DF group, drain placement was determined by intraoperative bloody exudate assessment approximately 30 s after 4DF application, classifying into drain (4DF + D, n = 23) and no-drain (4DF-D, n = 78) groups. Clinical characteristics, drainage volumes, and duration of drain placement were compared between groups.

No significant demographic differences existed between NHM and 4DF groups. Drain placement in 22.8% of the 4DF group, significantly associated with extensive surgery, larger tumor volume, and elevated anti-thyroid antibodies. Despite these higher-risk factors, total drainage volumes were similar between the 4DF + D and NHM groups (34.9 mL vs. 38.8 mL, p = 0.364). Almost all patients in the 4DF + D group (95.7%) had drainage > 20mL. Drainage volumes > 100mL occurred in two NHM group patients (1.9%), but not in the 4DF + D group. All drains in 4DF + D were removed by postoperative day 2.

Using 4DF during thyroid surgery reduced the need for drain placement by identifying high-risk patients through standardized intraoperative exudate assessment. This approach effectively controlled postoperative drainage and appeared helpful in preventing excessive exudate and enabling tailored drain management.