Intraoperative Hemostatic Agent Use and Risk of Post-Thyroidectomy Hypocalcemia: A Retrospective Cohort Study

Background: Post-thyroidectomy hypocalcaemia is one of the most frequent complications of thyroid surgery, with reported incidence ranging from 1.6% to 50%. While surgical technique and parathyroid preservation are well-established determinants, the role of intra-operative haemostatic agents remains uncertain. This study aimed to evaluate the association between haemostatic agent use and post-operative hypocalcaemia. Materials and Methods: We conducted a retrospective cohort study of adult patients who underwent total thyroidectomy at a tertiary care teaching hospital between August 2023 and August 2024. Patients with pre-existing hypocalcaemia, hypoparathyroidism, concomitant parathyroid surgery or completion thyroidectomy were excluded. Clinical and operative data were collected, including the use of haemostatic agents, calcium levels and hypocalcaemia symptoms. Hypocalcaemia was defined as serum calcium <8.0 mg/dL or <8.5 mg/dL with symptoms. Statistical comparisons were performed using Fisher’s exact test, with P < 0.05 considered significant. Results: Fifty patients met inclusion criteria. Haemostatic agents (oxidised regenerated cellulose, SURGICEL ™ FIBRILLAR) were applied in 25 patients, while 25 underwent surgery without adjuncts. All patients in the haemostatic group (100%) developed hypocalcaemia, compared with none in the non-haemostatic group (0%), a highly significant difference ( P < 0.001). Mean post-operative day 1 calcium was lower in the haemostatic group (7.4 ± 0.4 mg/dL) compared with the non-haemostatic group (8.7 ± 0.5 mg/dL, P < 0.001). Symptomatic hypocalcaemia requiring intravenous supplementation occurred in 15 of 25 patients (60%) in the haemostatic group, but in none of the controls. Conclusion: The use of intra-operative haemostatic agents was strongly associated with hypocalcaemia following thyroidectomy in this single-centre retrospective series. Although limited by the small sample size, the findings highlight a potential safety concern. Larger prospective studies are warranted, but until then, surgeons should use haemostatic agents selectively and ensure vigilant post-operative calcium monitoring.