Closed Wound Subfascial Suction Drainage in Posterior Fusion Surgery for Adolescent Idiopathic Scoliosis

Abstract

Study Design. A prospective randomized control study. Objective. The aim of this study was to compare the complication rate in adolescent idiopathic scoliosis (AIS) posterior spinal fusion (PSF) surgery with and without drainage. Summary of Background Data. PSF is the mainstay of surgical treatment for AIS. Drains are commonly used despite contradictory findings in the literature for their having any clear advantage. Methods. A total of 100 AIS patients undergoing instrumented PSF were blindly randomized into two groups of either a deep drain or no drain. The collected data included wound follow-up findings, hemoglobin, hematocrit, vital signs and fever levels, and mean 20 months follow-up. Results. Fifty-two patients were randomly allocated to the “no drain” group and 48 to the “drain” group. There were no differences in patient characteristics, surgical data, and hemoglobin and hematocrit levels between the two groups. Only 4 units of packed cells were given in total. Fever during the first postoperative 1 to 3 days was equal, but increased in the no drain group on day 6 (P = 0.017). Length of hospitalization was equal (6 days) for all the patients. The mean follow-up period was 20 months [8.5–30.7 (SD 6.4)]. Complications included one case (1.9%) of pneumonia in the “no-drain” group, wound dehiscence in two cases (3.8%) in the “no-drain” group and in one case (2.1%) in the “drain” group, and two cases (3.8%) of superficial wound infection in the “no-drain” group. There was no case of deep infection in either group. Conclusion. The current results indicate that there is no advantage to deep drainage in AIS patients undergoing PSF. The number of wound healing complications was low and identical for both the drain and no-drain groups. Level of Evidence: 2

Closed-suction drainage in thoracolumbar spinal surgery–clinical routine without evidence? a systematic review

“…None of the investigations found a longer length of stay or increased costs in the no-drain collective [26,34,37]. On the contrary, one investigation by Adogwa et al on patients treated with spinal decompression and fusion found a significantly longer length of hospital stay for the drain-use cohort compared to the no-drain cohort (5.0 vs. 2.8 days, p < 0.0001) [18].…”

“…In addition, there are two further prospective, randomised studies indicating that drains have no impact on wound healing. Ovadia et al showed that the number of wound healing complications was similar in the study and control groups [26]. Furthermore, Gubin et al performed an open label randomised control trial with a total of 155 patients.…”

“…Two prospective, randomised controlled studies of posterior spinal fusion in adolescent idiopathic scoliosis reported about postoperative fever. Ovadia et al included 100 patients with and without drainage [26]. Both groups showed no fever for the first three days but a significantly increased temperature in the no-drain group on day 6 (p = 0.017).…”

“…Four investigations dealt with the economic impact dependent on length of stay and cost depending on the use of drains [18,26,34,37].…”

Do drains help reduce the risk of complications after thoracoplasties in posterior spinal fusions for adolescent idiopathic scoliosis?

“…Drains are also used across surgical specialties because they are thought to reduce risk of SSI 16 . Ovadia et al [16] showed that drains did not lower wound complication or infection rate after surgical correction of AIS [2]. Kochai and Erkorkmaz [14] showed similar results.…”