Neck dissections: predicting postoperative drainage.

Abstract

Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage. Radical, modified radical, and selective neck dissections performed in conjunction with resection of a carcinoma of the upper aerodigestive tract over a 3-year period were evaluated. Total intraoperative blood loss at surgery, and amount and duration of postoperative drainage for each neck dissection were recorded. Seventy-nine neck dissections were performed on 52 patients, 27 (52%) of whom had bilateral neck dissections. Median drainage was 116.5 mL, 172 mL, and 319 mL for selective, modified radical, and radical neck dissections, respectively. Drainage differed significantly by type of neck dissection (P <.001). Drains remained in place a median of 4 days with no significant difference between different types of neck dissections. Drainage was clearly correlated with total intraoperative blood loss (Spearman correlation = 0.44, P <.001). The postoperative drainage per day was higher in radical neck dissections than modified radical neck dissections and lowest in selective neck dissections. This difference was not reflected in the duration that the drains would remain in place. Total intraoperative blood loss is a strong predictor of the amount and duration of postoperative drainage.