Closed suction drainage after orthopaedic surgery: evidence versus practice

Tucci, G; Amorese, Veronica; Romanini, Emilio

doi:10.1007/s10195-006-0118-9

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…Lawson Tait's "when in doubt, drain" was countered by Halsted (1898) who argued that "no drainage at all is better than the ignorant employment of it" [11,12]. Closed suction drains are commonly used in orthopaedic surgery to avoid the accumulation of postoperative haematomas/seromas [6]. Haematomas can potentially increase tissue tension and therefore decrease tissue perfusion in the peri-wound area.…”

Section: Discussionmentioning

confidence: 99%

“…This could have a detrimental effect on the wound with an increased risk of wound dehiscence and infection, and poor wound healing. The routine use of closed suction drains in orthopaedics has been controversial but the practice has endured despite the availability of studies that challenge it's efficacy and identify some potential drawbacks [3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Despite studies that challenge the efficacy of prophylactic drainage after clean orthopaedic procedures, prophylactic wound drainage continues to be practiced even with lack of clear evi-dence that they improve outcomes [1,[3][4][5]. The paucity of randomized controlled trials has not helped clinicians arrive at a definitive evidence-based position on the subject [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Ikpeme¹,

Ngim²,

Ilori³

et al. 2013

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Background: Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that challenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compartment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any significant advantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods: A prospective analysis of 62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomization process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infection, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was analysed using SPSS statistics version 20 (IBM Corp., New York). Results: There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteosynthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a significantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39 + 0.56 secs versus 2.03 + 0.41 secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Ikpeme¹,

Ngim²,

Ilori³

et al. 2013

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“…13,14 The use of suction drain in upper limb surgery is still controversial. 15,16,17 Various studies reported that postoperative use of suction drain leads to retrograde migration of bacteria causing infection and there will be more chances of blood loss that will be more • A total of 120 patients were selected as per selection criteria.…”

Section: Introductionmentioning

confidence: 99%

Upper Limb Fracture

Rasool¹,

Manzoor

Ali

2018

TPMJ

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Upper limb fractures are one of the common fractures presenting in Accident and Emergency departments. Some of the upper limb fractures need open reduction and internal fixation. Use of suction drains after upper limb surgery is still debatable issue. Some surgeons routinely use, others never use and few occasionally use. Objectives: Aim of this study was to compare the results of upper limb fracture surgery by using or not using the suction drains. Design: Quasi Experimental Design. Settings: Orthopedic department Aziz Bhatti Shaheed Teaching Hospital Gujrart. Period: From December 2015 to November 2016. Method & Material: Total 120 patients were selected as per selection criteria. In 60 patients we used suction drain post-operatively & remaining 60 patients without Suction drain. Results: In our study we selected 120 patients .Patients divided in two groups. In group A 60 patients included in the study. We did not use suction drain in these patients. In group B we also selected 60 patients of upper limb fractures. We used suction drain in these patients. We compared the results of both groups on the basis of superficial wound infection and pain. In group A, six patients developed superficial wound infection while four patients developed superficial wound infection in group. There was no difference in severity of pain in both groups. Conclusion: We concluded from our study that there is no added advantage of suction drain in upper limb fracture surgery.

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“…It can also impair the early postoperative rehabilitation. In a recent metaanalysis, there is no clear advantage of the use of suction drains, apart from reduced need for change of dressing after total knee arthroplasty (TKA) 34. Moreover, in patients who had undergone TKA with drainage, the risk of transfusion was higher 3…”

Section: Introductionmentioning

confidence: 99%

Outcome in primary cemented total knee arthroplasty with or without drain

Kęska

Paradowski

Witoński

2014

IJOO

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Background:Suction drain insertion is a common practice in orthopedic surgery, especially after joint arthroplasty to prevent the formation of a hematoma. Theoretically the use of a drain should diminish the volume of hematoma; however the literature has conflicting data. Some authors state that drainage evacuates fluid from a limited area only and can be a cause of infection due to retrograde migration of bacteria. It can also impair the early postoperative rehabilitation. The aim of this study was to evaluate the clinical outcome (especially postoperative pain) and intake of analgesics in patients who had undergone primary cemented total knee arthroplasty (TKA) with or without a postoperative drain.Materials and Methods:A prospective comparative study of 108 consecutive patients (121 knees) was conducted. They were divided into two groups: A study group, with no drainage and a control group with drain inserted at the end of surgery. A total of 121 patients were recruited into two groups. A study group consisted of 59 knees, in which we did not use drainage after TKA and a control group with 62 knees, in which drain was inserted post surgery. Both groups were comparable in terms of preoperative characteristics. The indication for TKA was osteoarthritis (n = 105) and rheumatoid arthritis (n = 16).Results:In patients without drainage we observed lower need for opioids, higher blood loss on the 1st postoperative day and a lower need for change of dressings. There were no statistically significant differences in terms of total blood loss, hidden blood loss, transfusion rate, range of motion, length of hospital stay or incidence of complications between the two groups. In 1 year observation there were no differences in clinical outcome between the two groups.Conclusions:The present study conclude that there is no rationale for the use of drain after primary TKA. There are benefits in terms of lower opioid intake, lower blood loss on the first postoperative day and lower need for dressing reinforcement during hospitalization.

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Closed suction drainage after orthopaedic surgery: evidence versus practice

Cited by 12 publications

References 18 publications

Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Upper Limb Fracture

Outcome in primary cemented total knee arthroplasty with or without drain

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