Association Between Collagen-Based Hemostatic Patch Use and Patient-Reported Recovery After Bilateral Thyroidectomy:...

Background/Objectives: Topical hemostatic agents are widely used in thyroid surgery, but their clinical value remains uncertain. We evaluated whether intraoperative use of a collagen-based hemostatic patch during bilateral thyroidectomy was associated with patient-reported recovery and postoperative complications. Methods: This retrospective cohort study included 193 patients undergoing bilateral thyroidectomy (98 received Hemopatch and 95 underwent conventional hemostasis without a patch). Pain and swallowing scores were summarized as medians with interquartile ranges and compared using two-sided Mann-Whitney U tests. Unadjusted mean differences with 95% percentile-bootstrap confidence intervals based on 10,000 independent-group resamples were reported as effect estimates. Multivariable proportional-odds ordinal logistic regression adjusting for age, sex, operative time, intraoperative blood loss, and pathology was performed as a sensitivity analysis. Results: Major postoperative complications were infrequent, with no statistically significant between-group differences. Patch use was associated with lower pain scores on POD7 (mean difference -0.34, 95% CI -0.59 to -0.09; p = 0.0008), POD30 (-0.11, 95% CI -0.22 to 0.01; p = 0.0223), and POD90 (-0.12, 95% CI -0.18 to -0.05; p = 0.0005), but not POD1. Swallowing disturbance was also associated with lower scores on POD7 (-0.35, 95% CI -0.67 to -0.03; p = 0.0068), POD30 (-0.17, 95% CI -0.38 to 0.05; p = 0.0272), and POD90 (-0.23, 95% CI -0.38 to -0.09; p = 0.0005), but not POD1. Scar satisfaction was associated with a higher mean score at 6 months (+0.46, 95% CI +0.21 to +0.71; p = 0.0018). Several associations remained significant after multivariable adjustment and Holm correction, although not all comparisons were robust to multiplicity adjustment. Conclusions: Collagen-based hemostatic patch use was associated with modest differences in selected patient-reported recovery measures. The magnitude and clinical importance of these differences remain uncertain. No statistically significant differences in major complications were observed, but the study was not powered to establish comparative safety for uncommon events. These exploratory findings require confirmation in prospective multicenter studies.