Abstract
BackgroundThyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.MethodsWe conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications.ResultsThere was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group.ConclusionsFluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains.Trial registrationISRCTN94715414
Highlights
Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence
We conducted a prospective randomised clinical trial to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-measured fluid accumulation
We hypothesised that if nonsuction drains have no significant effect on reducing fluid volumes in the thyroid bed following thyroid surgery, they are unlikely to have a beneficial effect if a lifethreatening bleed occurs
Summary
Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. No longer routinely utilised in colonic or biliary surgery [1,2] (because of an association with increased infection rates [3], discomfort [4] and hospital stay [5]), drain use following thyroid surgery remains common practice [6]. This may be because evidence negating their utility in terms of postoperative convalescence has been considered lacking in terms of both quality and quantity [5], especially with regard to nonsuction drains [5,7]. We conducted a prospective randomised clinical trial to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-measured fluid accumulation. Additional outcome measures assessed were visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications
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