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

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.