The effectiveness of fibrin sealants in head and neck surgery

The utilisation of fibrin sealants as adjuncts in haemostasis during head and neck surgery has garnered increasing attention, yet their clinical efficacy remains a subject of debate. This thesis evaluates the effectiveness of fibrin sealants in patients undergoing head and neck surgery through a systematic review and critique of methodology. The systematic review included 14 experimental and quasi-experimental studies with a combined total of 904 patients, comparing fibrin sealants to placebo or usual care. Primary outcomes focused on time to removal of surgical drain removal postoperatively and rate of wound complications. Secondary outcomes assessed drain volume output, surgical management of postoperative haematoma, and adverse events. The findings indicate a modest reduction in wound complications, including hematoma, seroma, infection, and dehiscence, among patients treated with fibrin sealants. There was a statistically significant reduction in drain volume output (mean difference -16.54 mL) and length of hospital stay (mean difference -0.84 days), suggesting potential benefits in discharge planning and resource utilisation. However, substantial clinical and statistical heterogeneity was observed, likely due to variations in surgical procedures, patient populations, and study methodologies. This heterogeneity complicates the interpretation and generalisability of results. A critical issue identified in this review is the inconsistent use of reporting standards, such as the CONSORT checklist. Many studies exhibited poor compliance with these guidelines, undermining the internal and external validity of the findings. Inadequate reporting on randomisation processes, blinding, and adverse events raises concerns about potential biases and the reliability of the reported outcomes. The lack of comprehensive adverse event data and selective outcome reporting further complicate the assessment of the safety profile of fibrin sealants. These limitations highlight the need for more rigorous and standardised reporting practices to enhance the transparency and reproducibility of research in this field. The thesis underscores the challenges associated with blinding in surgical RCTs, particularly the difficulty of blinding surgeons administering the intervention. In this context, blinding outcome assessors becomes crucial to minimise detection bias and ensure objective evaluation of the results. The study calls for improved methodological quality and adherence to reporting standards in future research to provide more definitive conclusions regarding the effectiveness and safety of fibrin sealants in head and neck surgery. The findings also suggest that, while fibrin sealants may offer certain clinical benefits, the observed reductions in wound complications and drain output are modest and should be interpreted with caution due to the significant heterogeneity and potential biases identified. In conclusion, this thesis provides a comprehensive evaluation of the current evidence on fibrin sealants in head and neck surgery, highlighting both their potential benefits and the limitations of existing research. The results underscore the need for more high-quality, rigorously designed studies with robust reporting to better inform clinical practice and optimise patient outcomes in surgical settings.

Author dc:creator

• Nguyen, Marie

Advisors dc:contributor.advisor

• Lockwood, Craig
• Foreman, Andrew
• School of Public Health : JBI

• fibrin tissue adhesive; head and neck surgery; hemostasis; surgical drainage; systematic review

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/2440/144940

OAI identifier oai:identifier

oai:digital.library.adelaide.edu.au:2440/144940