Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire.

Abstract

The risks of drains in spine surgery (e.g., increasing venous plexus bleeding, maintaining CSF leakage, and infections) must be balanced with their benefits (e.g., reduced rate of postoperative hematoma and seroma formation). Little is known about factors that influence surgeons' decision to employ a drain. We conducted a survey among German spine surgeons regarding their use of drains. Neurosurgical and orthopedic departments along with privately practicing neurosurgeons were invited to complete an online questionnaire featuring general and case-specific questions with regard to drain placement. We received 163 questionnaires (private practice and small-volume centers 36.1%, medium- and large-volume centers 43.6%, university centers 20.2%). Factors influencing the decision to use a drain include size of wound, type of procedure, hemostasis at the end of the procedure, and coagulopathies; factors found to be less important include overall blood loss, body mass index, and implants. 31% of surgeons will use drains for microdiskectomies. For other pathologies, percentages are as follows: anterior cervical diskectomy and fusion, 58%; cervical laminoplasty, 62%; hemilaminectomy for bisegmental lumbar stenosis, 69%; transpedicular instrumentation, 88%; vertebral body replacement for metastasis, 94%. Over half of those who usually employ a drain will not use a drain in cases of unintentional durotomy. In terms of indication, duration, and safety measures, use of drains in spinal surgery is heterogeneous. The majority of surgeons prefer drains to suction in most cases, except for microdiskectomies, for which only 31% will use a drain. Nearly all colleagues discontinue drains by day 4.