Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana

Abstract

To determine the optimum period for passive post-mastectomy drainage in Accra, Ghana, comparing early (day 4) to late (day 10) drain removal. Randomised prospective clinical study. Surgical Department, Korle Bu Teaching Hospital, Accra, Ghana Patients with breast cancer scheduled for total mastectomy and level 11 axillary clearance. Patients were randomised to one of the two groups: early (day 4) and late (day 10) passive drainage. Duration of hospital stay, seroma formation and postoperative wound infection. Forty five patients had 4-day drainage and 42 had 10-day drainage. Late removal of drains (Day 10) was associated with a significantly higher drainage (1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Late removal, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspirate volumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Early removal had a shorter hospital stay of 6.2 (+/-1.52) days compared to 11.07 (+/- 0.76) days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There was a low incidence of seromas when drainage was <30 ml/day at the time of drain removal. Post-mastectomy passive drains may be removed when drainage is <30 ml in 24 hours. When there is a persistent large volume of axillary drainage, patients should be counselled about the relative risks of early and late drain removal. For patients who do not find seroma aspiration unacceptable, early (day 4) removal appears preferable to late (day 10) removal of drains.