Selective use of drains in thyroid surgery

Shaha, Ashok R.; Jaffe, Bernard M.

doi:10.1002/jso.2930520409

Cited by 65 publications

(50 citation statements)

References 8 publications

(3 reference statements)

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“…Studies have shown that the average duration of drainage in uncomplicated head and neck operations is between 2-4 days. [7][8][9][10] The presence of drains may in fact encourage further drainage by stimulating tissue reactions or by creating a suction effect.…”

Section: Discussionmentioning

confidence: 99%

Postoperative drainage in head and neck surgery

Amir

Morar

Belloso

2010

annals

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INTRODUCTION A major factor affecting patients’ length of hospitalisation following head and neck surgery remains the use of surgical drains. The optimal time to remove these drains has not been well defined. A routine practice is to measure the drainage every 24 h and remove the drain when daily drainage falls below 25 ml. This study aims to determine whether drainage measurement at shorter intervals decreases the time to drain removal and hence the length of in-patient stays. PATIENTS AND METHODS A 6-month prospective observational study was performed. The inclusion criteria were patients who underwent head and neck surgery without neck dissection and had a closed suction drain inserted. Drainage rates were measured at 8-hourly intervals. Drains were removed when drainage-rate was ≤ 1 ml/h over an 8-h period. RESULTS A total of 43 patients were evaluated. The highest drainage rate occurred in the first 8 postoperative hours and decreased significantly in the subsequent hours. The median drainage rates at 8, 16, 24, 32 and 40 postoperative hours were 3.375, 1, 0, 0 and 0 ml/h, respectively. Applying our new removal criteria of ≤ 1 ml/h drainage rate, the drains were removed in 22 (51%) patients at the 16th postoperative hour; 37 (86%) were removed by 24 h after operation. In comparison, only nine (20.9%) patients could potentially be discharged the day after surgery if previous criteria of ≤ 25 ml/24-h were used to decide on drain removal. CONCLUSIONS Our 8-hourly drainage-rate monitoring has facilitated safe earlier discharge of an additional 28 (65%) patients on the day after surgery. This has led to improvement in patient care, better optimisation of hospital resources and resulted in positive economic implications to the department.

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Section: Discussionmentioning

confidence: 99%

Postoperative drainage in head and neck surgery

Amir

Morar

Belloso

2010

annals

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“…While some authors have recommended the routine use of drainage after thyroidectomy to prevent hematoma and to detect bleeding early [17,18,19,20,21], this recommendation has been debated extensively in the literature [5,6,22,23,24,25]. …”

Section: Discussionmentioning

confidence: 99%

Thyroid Surgery: To Drain or Not to Drain, That Is the Problem - A Randomized Clinical Trial

Schietroma

Pessia

Bianchi

et al. 2017

ORL

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Purpose: We conducted a prospective, randomized study to evaluate the necessity of drainage after thyroid surgery. Methods: The patients (n = 215) were randomly assigned to be treated with suction drains (group 1; n = 108) or not (group 2; n = 107). Results: The postoperative pain scores were significantly lower in the non-drained group than in the drained group of patients at postoperative days 0 and at 1. Hematomas, seromas, wound infections, transient biochemical hypoparathyroidism, and transient damage of the recurrent laryngeal nerve occurred more frequently in the drained group than in the non-drained group. The mean hospital stay was significantly shorter in the non-drained group than in the drained group. Conclusions: Routine drain emplacement after thyroidectomy is unnecessary.

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“…In the past most surgeons employed wound drains routinely with the hope of decreasing the risk of acute airway obstruction by hematoma as well as postoperative hematoma or seroma [1][2][3][4][5]. Several authors, however, have suggested that use of drains could increase the risk of infection, the length of hospital stay, treatment costs, and discomfort for the patient.…”

Section: Introductionmentioning

confidence: 99%

Routine drainage after thyroid surgery—A meta‐analysis

Sanábria

Carvalho

Silver

et al. 2007

Journal of Surgical Oncology

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Thyroidectomy is a common surgical procedure. The results of some clinical trials suggest that routine drainage does not offer advantages, but the evidence is not strong either in favor of or against this intervention. The effect of routine drainage compared to no drainage in patients subject to thyroidectomy was measured using a meta-analysis. After an extensive literature review, suitable randomized clinical trials were selected for analysis. Outcome measures included the comparative incidence of neck hematoma or seroma and length of hospital stay. Eleven randomized clinical trials were included. There were no statistically significant differences in the incidence of neck hematoma/seroma (OR 1.03, 95% CI 0.59-1.81) between the groups. The mean length of hospital stay was 1.53 days longer for the drainage group (95% CI 1.39-1.68). There was no difference found between routine drainage and no drainage with regard to the frequency of postoperative hematoma/seroma in patients following thyroidectomy. In addition, the mean length of hospital stay was longer in the routine drainage group.

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Selective use of drains in thyroid surgery

Cited by 65 publications

References 8 publications

Postoperative drainage in head and neck surgery

Postoperative drainage in head and neck surgery

Thyroid Surgery: To Drain or Not to Drain, That Is the Problem - A Randomized Clinical Trial

Routine drainage after thyroid surgery—A meta‐analysis

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