Outcomes of drain versus no drain in total knee arthroplasty: a retrospective cohort study

Abstract

Purpose The use of suction drains in total knee arthroplasty (TKA) remains controversial. The aim of this study is to compare the outcomes of patients who received suction drains versus those who did not, focusing on blood loss, blood transfusion need, and length of hospital stay. Methods A retrospective observational cohort study was conducted at a tertiary hospital between January 1, 2015, and December 30, 2019, and included 262 patients who underwent unilateral non-traumatic primary TKA and were over 18 years old. The Institutional Review Board (IRB) approved the study (MRC-02–20-278). Results A total of 262 patients were included, with an age range of 47 to 91 years. Most of the included patients were females, 74.4% (195). Hypertension was the most frequent risk factor, 67.6%, followed by diabetes. Of 262 patients, 156 (59.5%) received a drain. The drain group had significantly longer hospital stay, 30% longer tourniquet time, greater haemoglobin and haematocrit drops, higher count of transfused packed RBC units, and lower use of anticoagulants. Moreover, tranexamic acid (TXA) use (n = 106) in surgery reduced hospital stays, tourniquet time, drain output, and increased pre- and postoperative haemoglobin and hematocrit levels compared to no TXA group (n = 156) (p < 0.05, z-score reported). Conclusions This study found that patients who received a drain had longer hospital stays and greater blood loss and transfusion rates compared to those who did not. The use of TXA in surgery was associated with improved outcomes and reduced overall complications.

Evaluation of Tranexamic Acid Application without Closed-Suction Drainage versus with Closed Suction Clamping in Patients Undergoing Knee Arthroplasty: A Retrospective Assessment of Blood Loss and Transfusion

“…There is no consensus regarding the effect of CSD usage on LOS. While several studies have reported no signi cant difference, some large-scale studies have indicated that not using CSD can reduce LOS [22]. In our study, we observed a signi cant reduction in LOS in patients where CSD were not used, along with the combined use of local and systemic TA (P = 0.005).…”

Similar Short-Term Outcomes of Adolescent Idiopathic Scoliosis Surgery with or without Drainage: A Systematic Review of the Literature and Meta-Analysis

“…Previous literature has evaluated potential risks of drain use in lumbar spinal surgery and hip and knee arthroplasties, revealing a tendency for patients in which the drain was applied to receive more postoperative blood transfusions and to have a longer postoperative hospital stay [17][18][19][20][21]. [8,11].…”

Evaluating the Efficacy and Safety of Combined Administration of Systemic and Topical Tranexamic Acid in Total Knee Arthroplasty

“…In orthopedic procedures such as TKA, TXA is frequently utilized to minimize intraoperative and post-operative blood loss, thereby decreasing the need for blood transfusions and associated complications. Various studies confirmed the perioperative use of TXA provides a bloodless surgical field, reduces surgical drains, and thus prevents the need for allogeneic blood transfusion, and surgical drain [ 18 - 20 ].…”