The relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery: a multicenter retrospective study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Use of surgical site drains following posterior cervical spine surgery is variable, and its impact on outcomes remains controversial. Studies of drain use in the lumbar spine have suggested that drains are not associated with reduction of reoperations for wound infection or hematoma. There is a paucity of studies examining this relationship in the cervical spine, where hematomas and infections can have severe consequences. This study aims to examine the relationship between surgical site drains and reoperation for wound-related complications following posterior cervical spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This study is a multicenter retrospective review of 1799 consecutive patients who underwent posterior cervical decompression with instrumentation at 4 tertiary care centers between 2004 and 2016. Demographic and perioperative data were analyzed for associations with drain placement and return to the operating room.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of 1799 patients, 1180 (65.6%) had a drain placed. Multivariate logistic regression analysis identified history of diabetes (OR 1.37, p = 0.03) and total number of levels operated (OR 1.32, p &lt; 0.001) as independent predictors of drain placement. Rates of reoperation for any surgical site complication were not different between the drain and no-drain groups (4.07% vs 3.88%, p = 0.85). Similarly, rates of reoperation for surgical site infection (1.61% vs 2.58%, p = 0.16) and hematoma (0.68% vs 0.48%, p = 0.62) were not different between the drain and no-drain groups. However, after adjusting for history of diabetes and the number of operative levels, patients with drains had significantly lower odds of returning to the operating room for surgical site infection (OR 0.48, p = 0.04) but not for hematoma (OR 1.22, p = 0.77).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This large study characterizes current practice patterns in the utilization of surgical site drains during posterior cervical decompression and instrumentation. Patients with drains placed did not have lower odds of returning to the operating room for postoperative hematoma. However, the authors’ data suggest that patients with drains may be less likely to return to the operating room for surgical site infection, although the absolute number of infections in the entire population was small, limiting the analysis.</jats:p></jats:sec>

Minimizing Blood Loss in Spine Surgery

“…114,115 However, we generally place drains for patients undergoing open posterior procedures involving more than 2 levels owing to their ability to decrease rates of wound infection and return to the operating room for wound revision. 116…”

Postoperative Non-Pathological Fever Following Posterior Cervical Fusion Surgery : Is Laminoplasty a Better Preventive Method than Laminectomy?

“…High volumes of hematoma or seroma after drain catheter removal in patients who undergo more extensive surgery may also cause fever and tissue trauma, depending on when fever occurs 23) . In contrast, use of a drain at the surgical site was found to be unrelated to postoperative hematoma formation and wound dehiscence 11) . The incidence of postoperative non-pathologic fever after laminectomy was significantly higher than in patients who did not undergo laminectomy.…”

The risk factors of surgical site infection following posterior cervical spine surgery

“…At present, the relationship between SSI following posterior cervical spine surgeries and surgical site drains is still controversial. The surgical site drain was mainly started in cervical spine surgeries to prevent the formation of epidural hematoma or seroma which may cause neurological de cit and increasing the tension on the incisions resulting in wound-related complications namely SSI and wound dehiscence 24 . Wound drain apart from supposedly aiding in SSI prevention, could cause retrograde infection, increase post-operative blood loss which increases the need for blood transfusion.…”