Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection

Tamplen, Matthew; Tamplen, Jesse; Shuman, Elizabeth A.; Heaton, Chase M.; George, Julia D.; Wang, Steven J.; Ryan, William R.

doi:10.1001/jamaoto.2017.1414

Cited by 12 publications

(5 citation statements)

References 12 publications

(26 reference statements)

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“…To date, a number of studies have focused on post-operative drain management in specific populations of post-surgical patients [ 3 , 4 , 10 ]. However, few studies have focused on head and neck surgery [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Drain Output on the Timing of Closed Suction Drain (CSD) Removal After Head and Neck Surgery

Bohorquez¹,

Peña²,

Weed³

et al. 2022

Cureus

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Background: A closed suction drain (CSD) is often utilized in head and neck surgical procedures to obliterate dead space. CSDs reduce seroma and hematoma formation, thereby improving skin apposition and wound healing. The use of drains for prolonged periods of time, however, may increase the risk of wound infection. Interestingly, the evidence regarding the need for, and management of, post-operative CSDs after head and neck surgery is scarce. The current criterion of drain removal when output is less than 30 cubic centimeters (cm 3 ) within a 24-hour period and/or on the third post-operative day (POD) is widely utilized. The aforementioned criterion is based on anecdotal evidence from small studies with specific surgical procedures. In this study, we aim to evaluate the criteria for drain removal and to lay the groundwork for an updated paradigm for drain management in head and neck oncologic surgery. Study Design: Retrospective cohort study Setting: Academic tertiary care hospital Methods: A retrospective study was performed. Patients were included if they underwent head and neck surgery at the University of Miami Hospital between January 1, 2019 and July 1, 2020 and had at least one CSD. Volume of drain output on each POD was recorded until the day of drain removal. The development of post-operative wound complications (i.e., seroma, hematoma, infection/abscess, and dehiscence) was also recorded. Results: From our initial cohort of 302 patients, 145 patients met inclusion criteria. A total of 10 patients developed a post-operative wound complication. Patients had a mean age of 58.3 ± 15.0 years. The median inter-quartile range (IQR) drain output (cm 3 ) on the day of CSD removal from patients who developed a wound complication was similar (15; IQR, 5-37.5) when compared to those who did not develop a wound complication (25; IQR, 10-30). This difference was not statistically significant ( p = 0.60). Additionally, the cohort who developed a post-operative wound complication had their drain removed on an earlier POD (1; IQR, 1-1 (Mean 1.2)) when compared to the cohort who did not develop any complications (1; IQR, 1-1 (Mean 1.5)). This difference was also not statistically significant ( p = 0.48) . Conclusion: There is no association between drain output (cm 3 ) or day of CSD removal with the development of wound complications. These results warrant further studies to prospectively evaluate earlier CSD removal in head and neck surgery.

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Section: Discussionmentioning

confidence: 99%

Effect of Drain Output on the Timing of Closed Suction Drain (CSD) Removal After Head and Neck Surgery

Bohorquez¹,

Peña²,

Weed³

et al. 2022

Cureus

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“…Jedoch stellt die Drainage einen in das sterile Wundgebiet eingebrachten Fremdkörper dar. Eine verlängerte Liegedauer einer Wunddrainage ist mit einem gesicherten erhöhten Infektionsrisiko der postoperativen Wunde assoziiert [5][6][7]. Zusätzlich wird durch die Drainage eine länger offene Wundhöhle geschaffen, die nach Entfernung der Drainage eine zusätzliche Ansammlung von Wundflüssigkeit und Speichel begünstigen könnte [8,9].…”

Section: Evidenzlage Zur Wertigkeit Einer Wunddrainage Bei Speicheldrunclassified

Vorstellung einer europaweiten prospektiven Studie zur Wertigkeit einer Drainage bei Parotidektomie

Grosheva

Klußmann

Beutner

et al. 2020

Laryngorhinootologie

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Zusammenfassung Einleitung Zur Wertigkeit einer Wunddrainage bei einer Parotidektomie existieren keine validen klinischen Studien. Das Ziel der aktuellen Studie ist es zu untersuchen, ob durch die Einlage bzw. den Verzicht auf eine geschlossene Wunddrainage (sog. Redon) bei einer lateralen und partiellen Parotidektomie die Häufigkeit der postoperativen Komplikationen, wie Nachblutung, Wundheilungsstörung und Wundinfektion, sowie Speichelzyste und -fistel beeinflusst wird. Methoden Es wurde eine europaweite multizentrische, prospektive, randomisierte Studie geplant. Durch das Hauptprüfzentrum (HNO-Uniklinik Köln), in Kooperation mit den HNO-Universitätskliniken Jena und Göttingen, wurde das Studienprotokoll erstellt. Die Fallzahlberechnung wurde mit G*Power durchgeführt. Die Studie umfasst Probanden mit einer Indikation zu Parotidektomie bei einem gutartigen Tumor ohne bekannte Gerinnungsstörung oder weitergeführte Antikoagulation. Die präoperative Randomisierung und das Data Management erfolgen softwaregestützt (REDCap 9.1.24, Vanderbilt University). Ergebnisse Die Studie wurde 10/2019 durch die federführende Ethikkommission zustimmend bewertet und ist seit April 2019 offen. Zum aktuellen Zeitpunkt nehmen 9 HNO-Kliniken, davon 6 in Deutschland und 3 in Österreich, an der Studie teil. Hierbei werden in 7 Zentren aktiv Probanden eingeschlossen. Bei einer kalkulierten Follow-to-treat-Gruppengröße von 800 Probanden beträgt die geplante Laufzeit der Studie 4 Jahre. Schlussfolgerungen Die Redon-Studie ist die weltweit erste prospektive randomisierte Studie, die die Wertigkeit einer Drainageeinlage bei einer Parotidektomie untersucht. Um das Rekrutierungsziel in geplanter Zeit erreichen zu können, ist die Teilnahme weiterer spezialisierter Kliniken dringend notwendig. Wir möchten zudem alle HNO-Ärzte ermutigen, ihre Patienten auf die Redon-Studie aufmerksam zu machen, sie über die Möglichkeit zur Studienteilnahme aufzuklären und in eine der teilnehmenden Kliniken zu überweisen.

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“…Hematoma and seroma formation is linked to postoperative surgical drain output. Generally, an output of <50–100 ml over 24 h is accepted as an arbitrary threshold for safe surgical drain removal without increasing the risk of hematoma or seroma 17 . In this study, we performed a prospective randomized controlled trial to determine if the application of MPH during closure of the ALT donor site reduces postoperative drain output as well as seroma or hematoma formation.…”

Section: Introductionmentioning

confidence: 99%

Effect of microporous polysaccharide hemospheres on anterolateral thigh free flap donor site complications

David

Zebolsky

Park

et al. 2022

Laryngoscope Investig Oto

Self Cite

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Background: Postoperative seroma is the most common donor site complication following anterolateral thigh (ALT) free flap harvest for head and neck reconstruction.The utility of novel microporous polysaccharide hemospheres (MPH) has not been studied as a hemostatic agent in this setting.Methods: Prospective, single-blind, randomized controlled trial of patients undergoing fasciocutaneous ALT harvest for head and neck reconstruction at a tertiary academic medical center between April 2018 and February 2020. The intervention (MPH) group received 3 g of topical MPH to the ALT donor site prior to closure whereas the control group did not receive application of MPH. Outcomes included total drain output (ml), drain output during postoperative days (POD) 1-3 alone, drain duration (days), and incidence of donor site hematoma, seroma, or infection.Results: Twenty-nine patients were randomized to the MPH group and 26 to the control group. For MPH and control groups, mean total drain output was 284.7 ± 153.0 ml versus 317.9 ± 177.6 ml (p = .527), mean POD 1-3 drain output alone was 169.3 ± 88.8 ml versus 157.9 ± 78.7 ml (p = .749), and drain duration was 5.9 ± 1.5 days versus 6.5 ± 1.6 days (p = .144), respectively. There was no significant difference in seroma (p = .733), hematoma (p = .492), or infection (p = 1.000). Drain output was not significantly influenced by gender, age, body weight, or smoking habits. Conclusion:MPH administration to ALT free flap donor sites did not significantly improve drain output, hematoma formation, or seroma formation.

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Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection

Cited by 12 publications

References 12 publications

Effect of Drain Output on the Timing of Closed Suction Drain (CSD) Removal After Head and Neck Surgery

Effect of Drain Output on the Timing of Closed Suction Drain (CSD) Removal After Head and Neck Surgery

Vorstellung einer europaweiten prospektiven Studie zur Wertigkeit einer Drainage bei Parotidektomie

Effect of microporous polysaccharide hemospheres on anterolateral thigh free flap donor site complications

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