The Increased Total Cost Associated With Post-Operative Drains in Total Hip and Knee Arthroplasty

Bjerke-Kroll, Benjamin T.; Sculco, Peter K.; McLawhorn, Alexander S.; Christ, Alexander B.; Gladnick, Brian P.; Mayman, David J.

doi:10.1016/j.arth.2013.10.027

Cited by 44 publications

(30 citation statements)

References 22 publications

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“…In the present study using a standardised discharge protocol, the patients without CSD could be discharged from the hospital on average one day earlier after revision THA. The faster discharge is directly linked to reducing the overall costs of the joint replacement surgery and supports the results of Bjerke-Kroll et al [21] showing increased length of hospital stay in patients with post-operative drains. The present study was not able to detect differences in superficial or deep infections or early reoperation rates between the patients with or without CSD.…”

Section: Discussionsupporting

confidence: 66%

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

Fichman

Mäkinen

Lozano

et al. 2015

International Orthopaedics (SICOT)

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Section: Discussionsupporting

confidence: 66%

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

Fichman

Mäkinen

Lozano

et al. 2015

International Orthopaedics (SICOT)

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“…The results of this study may also have cost implications regarding drain use. Lowering healthcare associated costs is an ongoing objective of many low-and middle-income countries (LMICs), and the use of drains in orthopaedic surgery is associated with increased cost [4,30]. Khanal et al reported that cost of treatment, inclusive of drain use, was higher than other routine orthopaedic cases [19], and the average drain costs in similar studies have been cited as 25-30 USD [4,10].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

Oguzie¹,

Albright

Ali

et al. 2020

SICOT-J

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Introduction: Prophylactic surgical drains are commonly used in Nigeria following intramedullary nailing (IMN) of long bone diaphyseal fractures. However, evidence in the literature suggests that drains do not confer any benefit and predispose clean wounds to infection. This study compares outcomes between patients treated with and without prophylactic surgical drainage following diaphyseal long bone fractures treated with IMN. Methods: A prospective cohort study with randomization was conducted at a tertiary referral center in Enugu, Nigeria. Investigators included skeletally mature patients with diaphyseal long bone (femur, tibia, humerus) fractures treated with SIGN IMN. Patients followed-up at 5, 14, and 30 days post-operatively. The primary outcome was surgical site infection (SSI) rate. Secondary outcomes included post-operative pain at 6 and 12 h, need for blood transfusion, wound characteristics (swelling, ecchymosis, and gaping), need for dressing changes, and length of hospital stay. Results: Of the enrolled patients, 76 (96%) of 79 completed 30-day follow-up. SSI rate was associated with patients who received a prophylactic drain versus those who did not (23.7% vs. 10.5%, p = 0.007). There were no significant differences in transfusion need (p = 0.22), wound swelling (p = 0.74), wound ecchymosis (p = 1.00), wound gaping (p = 1.00), dressing change need (p = 0.31), post-operative pain at 6 h (p = 0.25) or 12 h (p = 0.57), or length of stay (p = 0.95). Discussion: Surgical drain placement following IMN of diaphyseal long bone fractures is associated with a significantly higher risk of SSI. Reducing surgical drain use following orthopaedic injuries in lower resource settings may translate to reduced infection rates.

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“…Bjerke-Kroll et al . suggested that the use of surgical drains in arthroplasty increases blood loss, transfusion requirements, and overall costs 4. However, when the decision is made to use surgical drains, attention to detail and technique is of the utmost importance.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive surgical technique for tethered surgical drains

Hess

Satpathy

Waligora

et al. 2017

IJOO

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A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

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The Increased Total Cost Associated With Post-Operative Drains in Total Hip and Knee Arthroplasty

Cited by 44 publications

References 22 publications

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

Minimally invasive surgical technique for tethered surgical drains

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