Largest study comparing parotidectomy with drain versus parotidectomy with tissue sealant.

Tissue sealant results in no difference in complications compared to the use of surgical drain.

Forgoing a drain following parotidectomy results in a shorter length of hospital stay.

Our study showed a significant cost saving when tissue sealant was used as opposed to surgical drain.

Sialocele and salivary fistula are recognised complications of parotid surgery and have been reported to be more common with less extensive parotidectomy. We investigated the efficacy of tissue sealant(Cunniffe et al., 2019) 1 as an alternative to surgical drainage in terms of length of hospital stay (LOS), cost, and incidence of wound complications.

The study comprised a retrospective review of a prospectively maintained parotidectomy database at a single tertiary Head and Neck referral centre between 2009 and 2020. Cases undergoing concomitant neck dissection or major skin resection were excluded. Patients were divided into Group 1 (without tissue sealant), and Group 2 (with tissue sealant). Patients were also divided based on extent of surgery 1) Extracapsular dissection/Partial superficial parotidectomy 2) Superficial/total parotidectomy.

Of 202 included patients, there were 146 in Group 1 (143 with drain), and 56 in Group 2 (7 with drain). Compared to Group 1, Group 2 had a significantly shorter LOS (mean 1.4 ± 0.98 versus 3.1 ± 1.29 days, p < 0.05) and estimated cost (€1386 versus €2736). There was no significant difference in the complication rates (15.8% Group 1 versus 10.7% Group 2, p = 0.50). Group 1 showed a higher incidence of complications in patients undergoing less extensive parotidectomy (19/70 versus 4/76, p = 0.02), whereas in Group 2, the difference was not significant (5/30 versus 1/26, p = 0.20).

The use of tissue sealant as an alternative to surgical drains after parotidectomy facilitates reduced LOS and cost savings without increase in morbidity.

Parotidectomy

Artiss

Fibrin sealant

Wound complications

Sialocele

Drain

© 2021 The Authors. Published by Elsevier Ltd on behalf of Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.