Efficacy of Closed Wound Suction Drainage After Single-Level Lumbar Laminectomy

Payne, David H.; Fischgrund, Jeffrey S.; Herkowitz, Harry N.; Barry, Robert; Kurz, Lawrence T.; Montgomery, David

doi:10.1097/00002517-199610000-00006

Cited by 118 publications

(84 citation statements)

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“…Surgical site infection after spinal surgery has been reported to occur in rates ranging from 0.3 to 20% of patients [2,6,7,12,[16][17][18][19][20][21][22][23]. Calderone et al [1] estimated that health care costs can increase up to fourfold once an infection is encountered after spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

2011

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15 of the 1,512 patients (0.99%) were identified as having evidence of postoperative deep wound infection. At least one pre-existing risk factor for deep infection was present in 8/15 pts (54%). Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) were the most commonly identified organisms (11/15 cases). The rate of deep wound infection was 1.20% (8/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 1.23% (4/324) of multilevel instrumented posterior spinal fusions, 1.37% (1/73) of open PLIF procedures, and 1.23% (1/81) of single-level instrumented posterior fusions. Deep infection was not observed in any patient who had uninstrumented spinal fusion (0/64). The deep infection rate for revision surgeries was 1.15% (1/87) and 0.55% (1/183) for trauma surgery. Increased rates of complications related to powdered vancomycin use were not identified in this series. Conclusion In this series of 1,512 consecutive spinal surgeries, the use of 1 g of powdered intraoperative vancomycin placed in the wound prior to wound closure appears to associated with a low rate deep spinal wound infection for both instrumented and uninstrumented cases. Rates of deep infection for instrumented fusion surgery, trauma, and revision surgery appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic adjunctive measure is warranted.

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Section: Discussionmentioning

confidence: 99%

Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

2011

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“…Payne et al [11] conducted a prospective randomized controlled study to determine the indications for closedsuction drainage after single-level lumbar laminectomy without fusion. They randomized 200 operative candidates into two groups based on the presence or absence of a drain and found two of 103 patients with a drain and one of 97 patients without a drain had wound infections develop.…”

Section: Discussionmentioning

confidence: 99%

Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

Kanayama

Oha

Togawa

et al. 2010

Clinical Orthopaedics &Amp; Related Research

101

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Background Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications. Questions/purposes We evaluated the efficacy of closedsuction drainage in single-level lumbar decompression surgery. Patients and Methods We retrospectively reviewed 560 patients who underwent single-level lumbar decompression or discectomy. We routinely used closed-suction drainage in all spinal surgeries until July 2003, and thereafter, we did not use drains in single-level lumbar decompression surgery. These two groups (298 patients in the group that received drains, 262 in the group that did not receive drains) were compared for rates of wound infection and epidural hematoma. Results Mean operating time (55 versus 56 minutes) and intraoperative blood loss (64 versus 57 mL) were not different between the two groups. None of 560 patients had a wound infection requiring surgical intervention. The rate of postoperative hematoma was 0.7% in the group that received drains (two of 298 patients) and 0% in the group that did not receive drains (zero of 262 patients).Conclusions In this study, the risk of wound infection and hematomas in single-level lumbar decompression surgery was not influenced by use of a drain. The use of postoperative wound drainage in patients with potential risk for epidural bleeding in situations such as multiple-level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases needs additional study.

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“…In addition, two patients in the drained cohort developed an epidural hematoma with transitory neurologic injury that resolved following surgical evacuation. Payne et al [85] performed a RCT in which 200 patients, who underwent ''single-level lumbar hemi-laminectomy for herniated disc or decompressive lumbar laminectomy for degenerative stenosis,'' [85] were randomized to receive a CSD placed beneath the lumbosacral fascia (n = 103) or no drain (n = 97). All patients received 48 h of antibiotic prophylaxis and all drains were removed on post-operative day two.…”

Section: Spine Surgerymentioning

confidence: 99%

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Reiffel

Barie

Spector

2013

Surgical Infections

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Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

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Efficacy of Closed Wound Suction Drainage After Single-Level Lumbar Laminectomy

Cited by 118 publications

References 0 publications

Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

Prophylactic intraoperative powdered vancomycin and postoperative deep spinal wound infection: 1,512 consecutive surgical cases over a 6-year period

Is Closed-suction Drainage Necessary for Single-level Lumbar Decompression?: Review of 560 Cases

A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

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