Wound drains in posterior spinal surgery: a meta-analysis

Abstract

BackgroundThe use of drains following posterior spinal surgery is controversial. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in posterior spinal surgery.MethodsAll randomized and non-randomized controlled trials comparing the use of closed suction drainage with no drainage in posterior spinal surgery were sought in PubMed, Medicine, Embase, and other Internet databases. All of the literature was searched and assessed by two independent reviewers, according to the standards of Cochrane systematic reviews. Data on functional and radiological outcomes in the two groups were pooled, which were then analyzed with RevMan software, version 5.2.ResultsFour randomized controlled trials (RCTs) and four non-RCTs met the inclusion criteria. Meta-analysis revealed that no significant differences were found regarding wound infection (P = 0.83), hematoma (P = 0.48), neurological injury (P = 0.21), estimated blood loss (P = 0.59), or dry and moderate dressing drainage between the groups. The number of patients with saturated dressings was larger in the no drainage group (P = 0.002).ConclusionsThere is no obvious evidence to support the application of closed suction drains for posterior spinal surgery. Because of the limited quality of the evidence currently available, more high-quality RCTs with better experimental designs and larger patient samples should be performed.

Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis—a single‐center experience of patient blood management in 210 cases

“…Our results are also limited by the lack of postoperative wound drainage data. It has been demonstrated that drainage affects wound dressing soilage, infection rate, and transfusion risk; however, whereas intraoperative blood loss was meticulously noted in the surgical and anesthesia chart, postoperative registration relied on the attending nurse or physician to note the information in the medical chart. We found that this reporting was inconsistent and deemed that the data would be biased, because the patients with high drainage production would be more likely to have drainage information noted in their chart.…”

Prevention of orthopaedic infection in spine surgery

“…A clinical study with the use of MRI showed a significantly lower size and incidence of haematomas on first postoperative day by closed suction drainage systems, however without significant difference in the clinical outcome at 6 months follow-up 50 . Neither the clinical studies found a significant difference concerning postoperative infection rates, wound dehiscence, blood loss or epidural haematomas between patients with or without closed drainage after a non-complex lumbar surgery 48,49,51 . The dressing saturation was higher in patients without drainage 60 .…”

“…The first ones are responsible for increased SSI rates and are not recommended, whereas the usefulness and the infection risk of the closed suction drainage are controversial 1 . It is known that the formation of postoperative haematomas can increase the SSI rate, as haematomas provide an excellent culture medium for bacteria 48 , increase potentially the incision tension and the spinal cord compression and finally can delay the wound healing 49 . A clinical study with the use of MRI showed a significantly lower size and incidence of haematomas on first postoperative day by closed suction drainage systems, however without significant difference in the clinical outcome at 6 months follow-up 50 .…”

“…The routine use of closed suction drainage in single-level lumbar decompression should thus be avoided, as they can potentially cause a retrograde infection 49 . Their need for multiple level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases has to be clarified 49 . When needed, they should be placed through a different incision and they should be removed as soon as possible 1 .…”

Knowledge Levels of Nursing Students for Surgical Drain Follow up and Care

“…Acil durumlarda kullanılmak üzere kolay ulaşılabilen en az iki tane nontravmatik özellikte klemp hazır bulundurulmalıdır (1, 9-11, 14-17, 21-25). Dren seviyesi aksi durum belirtilmedikçe hasta yatağından aşağıda tutulur eğer hastada lomber drenaj varsa dren bel seviyesinde, EVD'si var ise dren transdüseri foromen monro hizasında tutulmalıdır (5,9,20,21,24,(26)(27)(28). Drenlerin aktif şekilde işlev görmesi için tıkanıklıkların önlenmesi, negatif basınç ortamının sürdürülmesi gerekmektedir.…”