A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collection

Ahluwalia, Suki; Hannan, Siobhan; Mehrzad, Homoyoon; Crofton, M.; Tolley, Neil

doi:10.1111/j.1365-2273.2007.01382.x

Cited by 25 publications

(25 citation statements)

References 6 publications

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“…[2][3][4][5][6] Furthermore, no difference in perioperative complications (seroma, hematoma, hemorrhage) was found among the 3 types of surgical procedures (hemithyroidectomy, total thyroidectomy, total thyroidectomy with CND) in either group. There was no major bleeding in either group.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors showed significantly increased length of stay in hospital and infection rates in patients treated with drainage. [4][5][6][7][8] Some authors suggest that because drain insertion is associated with wound infection and because the routine insertion of neck drains is of no additional benefit, neck drains should only be used selectively after thyroidectomy and parathyroidectomy. Piromchai and colleagues 15 found no significant decrease in fluid collections when pressure dressings were used.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors have demonstrated that drainage after uncomplicated thyroid surgery, including total thyroidectomy, lobectomy and subtotal thyroidectomy, does not decrease the rate of complications related to postoperative bleeding. [2][3][4][5][6][7] Most hematomas are clinically apparent within 2-4 hours after surgery, and some occur 2-48 hours postoperatively. The diagnosis of wound hematoma is made by observing the neck and noticing a progressive collection under the skin or airway symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Others have suggested selective or no use of drains after thyroidectomy, since the use of drains does not prevent the development of postoperative hematoma and increases the length of postoperative stay in hospital. [2][3][4][5][6][7] Other authors have concluded that thyroidectomy without drains is safe, even when combined with central neck dissection (CND). 8 The present paper aimed to evaluate the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND (central and/or lateral).…”

mentioning

confidence: 99%

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Safety of thyroidectomy and cervical neck dissection without drains

et al. 2012

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Background: Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. Methods:The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. Results:We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. Conclusion:Thyroidectomy without drains is safe and effective, even in combination with CND.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Safety of thyroidectomy and cervical neck dissection without drains

et al. 2012

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“…in 2007 comparing suction drain to no drain found no difference in postoperative fluid collections and a prolonged hospital stay in the group with drains. In addition, all three patients who developed haematomas in this study were in the suction drain group [23] . A Cochrane meta-analysis performed that same year by Samraj and Gurusamy combined the results of 13 randomized controlled trials comparing drainage with no drainage.…”

Section: Drainsmentioning

confidence: 93%

Postoperative Bleeding

Williams¹,

Angelos²

2012

Thyroid Surgery

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Systematic review and meta-analysis of wound drains after thyroid surgery

Woods

Duignan

et al. 2014

British Journal of Surgery

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Background: Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.Results: Twenty-five RCTs were included in the meta-analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound-assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. -0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units). Conclusion:The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.

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A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collection

Abstract: Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay.

Cited by 25 publications

References 6 publications

Safety of thyroidectomy and cervical neck dissection without drains

Safety of thyroidectomy and cervical neck dissection without drains

Postoperative Bleeding

Systematic review and meta-analysis of wound drains after thyroid surgery

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