Complications of Neck Drains in Thyroidectomies: Systematic Review and Meta-Analysis

Abstract

Abstract Background Intraoperative placement of neck drains in thyroidectomy patients remains a widespread practice, despite prevailing evidence discouraging this practice. This systematic review and meta-analysis was conducted to update the currently available evidence base. Methods Two independent investigators performed a comprehensive literature search to identify randomized control trials that evaluated post-operative complications associated with neck drains. This was conducted using four databases: Medline, Web of Science, EMBASE and Cochrane. Identified articles were then screened using a strict eligibility criterion. 16 studies were included in the final quantitative analysis and assessed for risk of bias. All methods were in accordance with recommendations from the Cochrane Review Group, UK National Health Service Centre for Reviews and Dissemination, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our initial search yielded 743 articles and 16 were included for final quantitative synthesis. The overall analysis demonstrated that post-operative hematomas [pooled OR = 2.09 (1.04, 4.21); p=0.04] and surgical site infections [pooled OR = 3.85 (2.04, 7.28); p<0.01] were significantly more likely in the drained group. Furthermore, hospital stays were longer in the drained group [pooled mean difference = 0.88 days (0.56, 1.20); p<0.01]. There were no significant differences in fluid volumes within the thyroid bed between study groups [pooled mean difference = -2.30 mL (-4.82, 0.21); p=0.07]. Conclusion The drained patient group had overall higher odds of hematomas, surgical site infections and longer hospital stays. Therefore, we recommend against this practice of neck drain insertions in patients that have undergone thyroidectomies.