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

Schietroma, M; Pessia, Beatrice; Bianchi, Zuleyka; Vita, Fabiola De; Carlei, F; Guadagni, Stefano; Amicucci, Gianfranco; Clementi, Marco

doi:10.1159/000464137

Cited by 20 publications

(24 citation statements)

References 27 publications

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“…Our other finding that drain placement is associated with a longer hospital stay is similarly consistent with available literature, with one study reporting a reduction in cost per patient as a result of not having a drain . Drain placement has also been associated with an increased rate of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and wound infection, although these were not examined in our study . These observations are likely related to the experience and surgical volume of surgeons performing the procedure.…”

Section: Discussionmentioning

confidence: 80%

Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Maroun

Asmar

et al. 2019

The Laryngoscope

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Objective: To analyze the effect of drain placement on postoperative hematoma formation and other associated outcomes post-thyroid surgery in a large national cohort.Methods: This was a retrospective study that analyzed data from the 2016-2017 National Surgical Quality Improvement Program (NSQIP) public use files. Baseline characteristics and perioperative outcomes were compared between drain and no drain cohorts.Results: A total of 11,626 patients were included; 3281 had a drain placed intraoperatively and 8345 did not. Otolaryngologists were 6.98 times more likely to place a drain after thyroidectomy than general surgeons (P < .001), and patients undergoing subtotal or total thyroidectomy were 2.17 times more likely to have a drain placed than if undergoing partial thyroidectomy (P < .001). Drain placement did not reduce hematoma formation on both univariate and multivariate analyses (adjusted OR = 0.93, P = .696). A slightly larger proportion of patients underwent unplanned intubation postoperatively among those who had a drain placed (0.76% vs. 0.29%, P < .001). Patients who received a drain were on average 4.63 times as likely to remain in the hospital for 2 or more days compared to those who did not receive a drain.Conclusion: Drain placement did not significantly affect postoperative hematoma formation following thyroidectomy. Drain placement should not be routinely employed in these patients. However, surgeon judgement and intraoperative considerations should be taken into account, as to when to place a drain.

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Section: Discussionmentioning

confidence: 80%

Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Maroun

Asmar

et al. 2019

The Laryngoscope

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“…Drains can generally lead to a reduction in pain after surgeries such as total knee arthroplasty, but the results in this randomized prospective study were only confirmed in the early-term but not long-term follow-up [17]. However, in considering the postoperative pain in other disciplines, Schietroma et al found that routine drain placement after thyroidectomy is not necessary, and avoiding drainage was associated with less postoperative pain [44]. The controversial results in between the trials mentioned above lead ultimately to different conclusions which are possibly subject-specific.…”

Section: Possible Complications and Side Effects After Placement Of Smentioning

confidence: 75%

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

et al. 2020

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Background For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. Method We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. Results Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). Conclusions Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.

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“…This poses the question of whether drain volume is clinically relevant. Drains are used less often in modern thyroid surgery; a recent RCT suggested their use was unnecessary. The use of drains to reduce postoperative bleeding is seen to have no significant effect and may potentially prolong hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Network meta-analysis of topical haemostatic agents in thyroid surgery

Polychronidis

Hüttner

Contin

et al. 2018

British Journal of Surgery

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

Cited by 20 publications

References 27 publications

Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Drain placement in thyroidectomy is associated with longer hospital stay without preventing hematoma

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

Network meta-analysis of topical haemostatic agents in thyroid surgery

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