Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

Muthu, Sathish; Ramakrishnan, Eswar; Natarajan, Karthick Kumar; Chellamuthu, Girinivasan

doi:10.1007/s00586-020-06540-2

Cited by 22 publications

(37 citation statements)

References 43 publications

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“…Drains were initially used in spine surgery to mitigate the risk of epidural hematoma (EDH) formation and reduce surgical site infections (SSI) [1]. The formation of a hematoma in the epidural space can potentially cause a mass effect on the neural elements, leading to permanent neurological deficits if not recognized and addressed expeditiously [1][2][3]. A large paraspinal hematoma may place tension on the surgical incision, risking poor wound healing and SSI [1].…”

Section: Introductionmentioning

confidence: 99%

“…The formation of a hematoma in the epidural space can potentially cause a mass effect on the neural elements, leading to permanent neurological deficits if not recognized and addressed expeditiously [1][2][3]. A large paraspinal hematoma may place tension on the surgical incision, risking poor wound healing and SSI [1]. Both are serious complications every practising spine surgeon seeks to avoid and are the two most common reasons spine surgeons cite using drains [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…A large paraspinal hematoma may place tension on the surgical incision, risking poor wound healing and SSI [1]. Both are serious complications every practising spine surgeon seeks to avoid and are the two most common reasons spine surgeons cite using drains [1][2][3][4]. Notably, although drains are placed with the intent of preventing SSI, as indwelling foreign bodies they too, are a known risk factor for the development of SSI [1,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Both are serious complications every practising spine surgeon seeks to avoid and are the two most common reasons spine surgeons cite using drains [1][2][3][4]. Notably, although drains are placed with the intent of preventing SSI, as indwelling foreign bodies they too, are a known risk factor for the development of SSI [1,4,5]. Additionally, postoperative symptomatic EDH formation is extremely rare, occurring in one of every 500 cases [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Notably, although drains are placed with the intent of preventing SSI, as indwelling foreign bodies they too, are a known risk factor for the development of SSI [1,4,5]. Additionally, postoperative symptomatic EDH formation is extremely rare, occurring in one of every 500 cases [1,[3][4][5]. Thus, some spine surgeons argue that drains provide minimal clinical benefit while putting patients at unnecessary risk of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Fowler¹,

Arshad²,

Siddiqi³

2022

Cureus

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No guidelines currently exist for surgeons to follow regarding drain use after spine surgery for degenerative disc disease. Therefore, we conducted a literature review to determine what situations warrant drain placement versus those which do not. When placed, we further investigate optimal drain duration. The goal of this article is to provide spine surgeons insight into the current literature and guidance when deciding if a drain should be used or discontinued. We performed a PubMed search and analyzed 44 peer-reviewed journal articles. Only studies that had the full article available were included. The highest-quality studies that were reviewed, demonstrated that in most situations using a drain is not associated with superior outcomes. It revealed that when drains are retained for a longer duration they run a greater risk of surgical site infection (SSI). Additionally, drains are associated with increased blood loss, a greater chance of requiring blood transfusions, and longer hospital stays. We conclude that drains are currently being overused in spine surgery for cases of degenerative disc disease, which exposes patients to unnecessary complications while providing minimal benefit.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Fowler¹,

Arshad²,

Siddiqi³

2022

Cureus

View full text Add to dashboard Cite

show abstract

Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis

et al. 2022

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Purpose This systematic review and meta-analysis aimed to determine the incidence of symptomatic spinal epidural hematoma (SSEH) following spine surgery. Methods We systematically searched for all relevant articles that mentioned the incidence of SSEH following the spine surgery published in the PubMed, Embase, and Cochrane Library databases through March 2022 and manually searched the reference lists of included studies. The Newcastle–Ottawa quality assessment scale (NOS) was used to assess the quality of the included studies. A fixed-effects or random-effects model was performed to calculate the pooled incidence of the totality and subgroups based on the heterogeneity. The potential publication bias was assessed by Egger's linear regression and a funnel plot. Sensitivity analysis was also conducted. Results A total of 40 studies were included in our meta-analysis based on our inclusion and exclusion criteria. The overall pooled incidence of SSEH was 0.52% (95% CI 0.004–0.007). In the subgroup analysis, the pooled incidence of SSEH in males and females was 0.86% (95% CI 0.004–0.023) and 0.68% (95% CI 0.003–0.017). Among the different indications, a higher incidence (2.9%, 95% CI 0.006–0.084) was found in patients with deformity than degeneration (1.12%, 95% CI 0.006–0.020) and tumor (0.30%, 95% CI 0.006–0.084). For different surgical sites, the incidences of SSEH in cervical, thoracic and lumbar spine were 0.32% (95% CI 0.002–0.005), 0.84% (95% CI 0.004–0.017) and 0.63% (95% CI 0.004–0.010), respectively. The incidences of SSEH in anterior and posterior approach were 0.24% (95% CI 0.001–0.006) and 0.70% (95% CI 0.004–0.011), respectively. The pooled incidence of SSEH was five times higher with minimally invasive surgery (1.94%, 95% CI 0.009–0.043) than with open surgery (0.42%, 95% CI 0.003–0.006). Delayed onset of SSEH had a lower incidence of 0.16% (95% CI 0.001–0.002) than early onset. There were no significant variations in the incidence of SSEH between patients who received perioperative anticoagulation therapy and those who did not or did not report getting chemopreventive therapy (0.44%, 95% CI 0.006–0.084 versus 0.42%, 95% CI 0.003–0.006). Conclusion We evaluated the overall incidence proportion of SSEH after spine surgery and performed stratified analysis, including sex, surgical indication, site, approach, minimally invasive surgery, and delayed onset of SSEH. Our research would be helpful for patients to be accurately informed of their risk and for spinal surgeons to estimate the probability of SSEH after spine surgery.

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Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study

El-Fiky¹,

Shehata

Nafady³

2023

Brain and Spine

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Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

Cited by 22 publications

References 43 publications

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis

Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study

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