Fibrin sealants in soft-tissue surgery of the head and neck: a systematic review and meta-analysis of randomised controlled trials.

Fibrin sealants in soft-tissue surgery of the head and neck: a systematic review and meta-analysis of randomised controlled trials.

Clin Otolaryngol. 2017 Jan 28;:

Authors: Bajwa MS, Tudur-Smith C, Shaw RJ, Schache AG

Abstract
BACKGROUND: Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft-tissue head and neck surgery has not been established.
OBJECTIVES: To assess if FS improves wound related outcomes in patients undergoing soft-tissue surgery of the head and neck anatomical region that would commonly require a drain.
TYPE OF REVIEW: Systematic review and meta-analysis of randomised controlled trials (RCTs).
SEARCH STRATEGY: Medline (1946 - 2016), EMBASE (1974 - 2016), PubMed (2016), CENTRAL (2016), ClinicalTrials. gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016).
EVALUATION METHOD: Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form.
RESULTS: Of the 421 studies that were screened 11 RCTs met the inclusion criteria. There were 2 RCTs on thyroidectomy, 3 on 'surgery involving neck dissection' (central or lateral), 5 on rhytidectomy and 1 on parotidectomy. There was a tendency for FS to reduce 'mean total drainage volume' (mean difference -26.86ml, 95%CI -43.41 to -10.31, I(2) =97%, p=0.001). Sub-group analysis of thyroidectomy (mean difference -36.36ml, 95%CI -72.82 to 0.10, I(2) =79%, p=0.05), 'surgery involving neck dissection' (mean difference -33.21ml, 95%CI -70.01 to 3.59, I(2) =94%, p=0.08) and rhytidectomy (mean difference -13.79ml, 95%CI -17.57 to -10.01, I(2) =0%, p<0.00001) concurred with the overall analysis. There was a suggestion that FS may reduce 'mean retention time of drains' by 1.24 days (95%CI -3.32 to 0.85, I(2) =99%, p=0.25) and 'hospital length of stay' by 2.09 days (95% CI -5.18 to 0.99, I(2) =97%, p=0.18) but this was not statistically significant. There was also a suggestion that FS may protect against adverse events (RR 0.69, 95%CI 0.35 to 1.38, I(2) =0%, p=0.29) and haematoma/seroma formation (RR 0.49, 95%CI 0.22 to 1.07, I(2) =0%, p=0.07).
CONCLUSIONS: There was considerable heterogeneity within the RCTs included in this study thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft-tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection. This article is protected by copyright. All rights reserved.

PMID: 28130927 [PubMed - as supplied by publisher]

http://ift.tt/2jrJtCT