Closed Suction Drainage Research Articles

Influence of Closed Suction Drainage After Total Knee Replacement.

Influence of Closed Suction Drainage After Total Knee Replacement.

Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study

BackgroundIn an enhanced recovery after surgery program, not placing a closed suction drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable. However, the influence of drain use on transfusion rate and postoperative length of stay (PLOS) in TJA remains controversial. Therefore, we aimed to compare drain use with no drain in routine primary TJA to determine the differences in transfusion rate and PLOS.MethodsWe analyzed the data from 12,992 patients undergoing primary unilateral TJA: 6325 total knee arthroplasties (TKA) and 6667 total hip arthroplasties (THA). Patients were divided into two groups according to whether they received a drain postoperatively following TKA and THA. We extracted information for transfusion and PLOS from patients’ electronic health records and analyzed the data by logistic and linear regression analyses.ResultsThe transfusion rate and PLOS were 15.07% and 7.75 ± 3.61 days, respectively, in the drain group and 6.72% and 6.54 ± 3.32 days, respectively, in the no-drain group following TKA. The transfusion rate and PLOS were 20.53% and 7.00 ± 3.35 days, respectively, in the drain group and 13.57% and 6.07 ± 3.06 days, respectively, in the no-drain group following THA. After adjusting for the following variables: age, gender, body mass index, orthopedic diagnoses, hypertension, type 2 diabetes, coronary heart disease, chronic obstructive pulmonary disease, preoperative hemoglobin, albumin, analgesic use, anesthesia, American Society of Anesthesiologists class, tranexamic acid use, intraoperative bleeding, operative time, and tourniquet use (for TKA), drain use correlated significantly with a higher transfusion rate (risk ratio = 2.812, 95% confidence interval (CI) 2.224–3.554, P < 0.001 for TKA and risk ratio = 1.872, 95% CI 1.588–2.207, P < 0.001 for THA) and a longer PLOS (partial regression coefficient (B) = 1.099, 95% CI 0.879–1.318, P < 0.001, standard regression coefficient (B′) = 0.139 for TKA; B = 0.973, 95% CI 0.695–1.051, P < 0.001, and B′ = 0.115 for THA). Two groups showed no significant difference in wound complications.ConclusionsOur findings indicated that drain use was associated with a higher transfusion rate and a longer PLOS in patients undergoing routine primary TJA. The routine use of postoperative drainage is not recommended in primary unilateral TJA.

Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis

There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF) rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT) was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95%CI)) as an effect measure was utilized. Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD) were included. In meta-analysis of all studies, overall [OR (95%CI) = 0.81 (0.42, 1.56); p = 0.53; I2 = 79%; Tau2 = 0.54]; grade A [OR (95%CI) = 0.71 (0.33, 1.53); p = 0.39; I2 = 65%; Tau2 = 0.47]; grade B [OR (95%CI) = 1.23 (0.74, 2.05); p = 0.42; I2 = 0%]; and grade C [OR (95%CI) = 1.08 (0.56, 2.09); p = 0.82; I2 = 5%] POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI) = 1.55 (0.79, 3.04); p = 0.20; I2 = 0%]. No publication bias was found (t = 0.48; p = 0.64). This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.

Effect of Flap Fixation Technique in Modified Radical Mastectomy on Incidence of Postoperative Seroma Formation.

To determine the efficacy of flap fixation technique on formation of postoperative seroma after modified radical mastectomy. Quasi-experimental study. General Surgery Department, PIMS Hospital, Islamabad, from August 2014 to February 2015. This study included 70 female patients, aged 16 to 70 years, undergoing modified radical mastectomy, randomly divided into two groups of 35 each, Group A (flap fixation) and Group B (non-flap fixation). Flap fixation was done by suturing flaps by absorbable, fine suture to underlying pectoralis fascia to obliterate the dead space. Two closed suction drains were used in both groups. Patients were discharged on the second postoperative day. Patients and their attendants were thoroughly educated about record of drain output. Patients followed in OPD after one week. Drains were removed when fluid output was less than 50 ml/day. After removal of drains, patient were again called for weekly follow-ups in surgical OPD. Formation of seroma was diagnosed clinically as collection of fluid under the mastectomy flaps and axilla seen as fluctuant, non-tender swelling. Data was collected on proforma designed for the study and analysed by SPSS version 20.0. Flap fixation group had 2 (5.7%) cases of seroma formation while control group had 3 (8.6%) cases of seroma formation. The difference between both groups statistically was insignificant (p=0.643). Flap fixation technique has no statistically significant effect on reducing frequency of seroma formation in patients undergoing modified radical mastectomy.

Thyroidectomy with and without drains: a clinical comparative study

Background: Thyroid surgery is one of the most commonly performed procedures by a general surgeon, and almost every surgeon tends to use closed suction drain at the end of surgery, with an intention of preventing the most dangerous complication i.e., suffocating haematoma, which may be not necessary as suggested by many studies. The objective of the study was to assess the benefit of drain use after thyroidectomy by determining; length of hospital stay, post operative pain and wound sepsis.Methods: This prospective clinical comparative study was undertaken at tertiary care teaching Hospital, for duration of one year from September 2017 to August 2018.Results: A total of 44 patients were evaluated. There were 29 females (65.90%) and 15 males (34.09%). The mean age for the drain group was 35.45 years and 33.79 years for the no drain group. Most participants were female. Mean duration of hospital stay after thyroidectomy was significantly higher among the drain arm as compared with the no drain arm. Seven patients developed complications in the drain group and one developed complication in the no drain group. The mean hospital stay of the drain group was 3.15 days which in the no drain group was 2.51 days.Conclusions: Thyroidectomy without drains causes less discomfort, early discharge, hence has lesser expenses, without increasing the risk of post operative including haemorrhage and hematoma formation. Meticulous haemostasis and an adequate surgical technique are the keys for avoiding haemorrhage and hematoma formation.

Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090-0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

One- or Two-Level Transforaminal Lumbar Interbody Fusion without Closed-Suction Wound Drainage

Background Data: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures. Purpose: To estimate the advantages and disadvantages of performing one- or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage. Study Design: Retrospective clinical cohort study. Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. Twenty-eight patients were females and 8 were males. Thirty patients had single-level TLIF and 6 double-level TLIF. The results of these patient series were retrospectively analyzed. The variables that were reviewed included blood transfusion, postoperative temperature, postoperative pain and the use of opiates during hospital stay, duration of surgery, duration of hospital stay, and incidence of postoperative complications such as neurological deficit, hematoma, postoperative wound infection, and revision surgery. Results: There was no postoperative allogenic blood transfusion; the patients did not develop postoperative neurological deficit; there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, which was treated conservatively with frequent dressing and antibiotics. Four patients (11.1%) developed transient postoperative fever. The mean pain score in the first 2 days after surgery assessed by the Visual Analogue Score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%). Conclusion: Performing one- or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the rate postoperative infection or hematoma formation. Additionally, none of our patients required postoperative blood transfusion. (2018ESJ168)

244 Closed Suction Drain Outputs at 12 and 24 Hours After Primary Three-Piece Inflatable Penile Prosthesis Surgery

Penile prosthesis placement is an effective and safe treatment option for erectile dysfunction. It is also associated with high satisfaction and recommendation rates of 85% and 88%, respectively.1 Hematoma formation after placement of penile prosthesis is a common complication with reported rates between 0.5 to 3.6%.2 In addition, hematoma formation may be responsible for slower recovery, prolonged postoperative discomfort, delayed pump cycling, and pump migration which may result in subsequent lead to revision surgery.3 Some surgeons believe that the use of close suction drains may increase penile prosthesis infection rates. However, this hypothesis has not been proven in the urologic literature. The aim of this study was to investigate the impact of close suction drainage during penile prosthesis placement in hematoma formation and infection rates. This is a single-institution retrospective review of closed suction drain outputs in primary three-piece IPP cases performed between 2014 and 2017 by a single surgeon. All patients underwent intraoperative placement of a closed suction drain (CSD). Patients also underwent postoperative compressive dressing using a 4-inch Kerlix TM dressing roll applied to the penile shaft and scrotum in the standard Mummy Wrap fashion. All devices were left fully inflated until drain removal on postoperative day 1. The main outcomes evaluated were the drain outputs at 12 and 24 hours postoperatively. Secondary end points were 30-day postoperative hematoma formation and IPP infections.

50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery.

While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding. A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003-2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs. Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons. This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Advantages of clamping and drainage over continuous drainage in a total knee arthroplasty

IntroductionThe use of closed-suction drainage systems after total knee arthroplasty (TKA) is common practice in India, but with no consensus on its use. In this retrospective study, we compared whether clamped or unclamped drainage has any advantages over the other in unilateral TKA. MethodsGroup-A (n = 351) had an unclamped drain removed at 24 h postoperative, with measurement of total drainage at 24 h between January 2011 and February 2013. Group B (n = 349) had drains kept for a total of 8 h-clamped for the first 4 h and unclamped for a further 4, between March 2013 to September 2016. Drainage volume, as well as the hemodynamic markers-hemoglobin (Hb) drop, transfusion rate were evaluated. ResultsMean drain output in Group- A was significantly higher than Group- B (215.64 ml versus 28.34 ml). The postoperative Hb was significantly higher in Group-B (11.46 g/dl versus 10.57 g/dl). Mean Hb drop was significantly higher in Group A (2.16 g/dl versus 1.18 g/dl). The transfusion rates were lower in Group-B, though not statistically significant. ConclusionsThe 4- hour clamping method effectively reduces drain output and fall in hemoglobin. For those who continue using closed suction drains, clamping could prove to be an effective way of reducing post-operative blood loss and the need for transfusions.

Closed suction drain outputs at 12 and 24 hours after primary three-piece inflatable penile prosthesis surgery.

This is a single-institution retrospective study of closed suction drain outputs in primary three-piece IPP cases performed between 2014 and 2017 by a single surgeon. The aim was to investigate the impact of closed suction drains (CSD) during penile prosthesis placement. One hundred and sixty-nine patients underwent intraoperative placement of a closed suction drain. Drain outputs were measured at 12 and 24 h, and postoperative complications were documented. There were no hematomas or infections observed within the patient cohort. The drain output decreased significantly between the first and subsequent 12 h period. Surgical time was associated with statistically significant increases in CSD output at 12 and 24 h with a near linear relationship between surgical times and CSD at 12 and 24 h. Penile prosthesis placement in patients on aspirin did not affect the CSD output volume. Closed suction drains should be considered in all patients undergoing placement of inflatable penile prosthesis, particularly in those cases with longer operative time.

A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty.

PurposeDespite the long history of drain use in total knee arthroplasty (TKA), no drain has been gaining popularity. The purpose of this study was to investigate whether drainage is related to the length of hospital stay.Materials and MethodsA total of 166 consecutive unilateral TKAs performed on 135 patients with osteoarthritis were retrospectively reviewed. Closed suction drainage was used in 111 cases (67%). Length of hospital stay after surgery was recorded, and a multivariate linear regression analysis was performed to evaluate various variables (patient factors, surgical factors, and post-surgical factors) and to investigate whether drainage was an independent variable.ResultsHospital stay was shorter in no drain cases (21.7±4.8 days) than in drain cases (24.2±3.7 days, p<0.001). The multivariate analysis showed that older age (β=0.12, p=0.02), drain use (β=2.81, p=0.03), and occurrence of comorbidity (β=1.46, p=0.04) were the independent variables associated with the extended hospital stay. There was no difference in comorbidity between drain cases (39.6%) and no drain cases (27.2%, p=0.13).ConclusionsThe drain use, age, and occurrence of comorbidity were related to the length of hospital stay. TKA without drain is an effective procedure both medically and economically.

Surgical decision making in patients with cirrhosis: a systematic review of the literature

Background: The incidence of cirrhosis is increasing and many patients affected by this disease process will require some form of operation (elective vs emergent). In these individuals, the decision making process can be quite demanding. These individuals require adequate assessment for the degree of hepatic dysfunction, extent of both portal hypertension and their comorbidities for perioperative optimization. Some of the common operations performed in patients with cirrhosis involve biliary, colorectal disease and ventral hernias. The primary aim of this study is a systematic review of the literature to determine the decision making process involved with three common emergent surgical cases. Methods: A systematic review of the literature using Pubmed, Medline and Embase was performed. Non case reports and retrospective reviews of patients with cirrhosis undergoing emergency surgery were identified. In addition to the systematic review, 3 specific cases were utilized to highlight the issues involving patients with cirrhosis and common gastrointestinal emergencies. These cases involved patients with cirrhosis who developed: ischemic bowel, acute cholecystitis and an incarcerated umbilical hernia. The decision making aspect in each case involved deciding whether to perform a primary anastomosis post bowel resection versus creation of a stoma, laparoscopic cholecystectomy versus percutaneous drainage and finally the ideal management of an incarcerated umbilical hernia with ascites. Results: High grade evidence for decision making is lacking. In patients with cirrhosis complicated by ischemic bowel, individuals with Child Pugh A or a MELD score <10 display the best outcomes. Whether to create a stoma versus resection and primary anastomosis in end stage liver disease, there is no level 1 evidence to support either. There were no studies identified for this patient population and most studies involved individuals with colorectal disease. However, in the French Association of Surgery series, patients with cirrhosis that had a protective stoma are at risk for stoma complications such as ascites leakage, ascites infection, peristomal varices. There was a 7% fistula rate in individuals with resection and primary anastomosis. Acute cholecystitis in patients with Child Pugh A/B can be treated with laparoscopic cholecystectomy and or subtotal cholecystectomy. For Child Pugh C medical management should be attempted followed by percutaneous transhepatic cholecystostomy tube as necessary. Finally, individuals with an incarcerated umbilical hernia should have emergent surgery and repair of their hernia. Intraoperatively placed closed suction drains can be used to control post-operative ascites and allow for adequate wound healing. Ascites should also be managed aggressively with medical therapy and possible emergent Transjugular Intrahepatic Portosystemic Shunt (TIPS) as necessary. Conclusion: Advanced liver disease complicates many common gastrointestinal surgeries. The decision making process surrounding these operations is far from standardized as high grade evidence recommending optimal management is lacking. Management of cirrhosis in these not un- common emergency settings rely mostly on retrospective data and small cohort studies thus the treatment can vary from surgeon to surgeon.

Impact of closed suction drainage after surgical fixation of acetabular fractures.

The purpose of the present study was to evaluate the prevalence of closed suction drainage after a Kocher-Langenbeck (K-L) approach for surgical fixation of acetabular fractures and to determine the impact of closed suction drainage on patient outcomes. This retrospective study reports on 171 consecutive patients that presented to a single level I trauma center for surgical fixation of an acetabular fracture. Medical records were reviewed to evaluate the use of closed suction drains. The primary outcomes measures were rate of packed red blood cell (PRBC) transfusion and length of hospital stay (LOS). Secondary outcome measures were 30-day post-operative wound complication and 1-year deep infection rates. Of the 171 patients included in this study, 140 (82%) patients were treated with drains. There was a significant association between the use of closed suction drainage and post-operative blood transfusion rate (p = 0.002). Thirty-five patients (25%) treated with drains required a post-operative blood transfusion compared to 0% in the no drain cohort. Regarding the total number of drains used, for every additional closed suction drain that was placed beyond a single drain, the odds of receiving a blood transfusion doubled (p = 0.002). Use of closed suction drainage was associated with a significantly longer LOS (p = 0.015), and no difference in wound complication or deep infection rates. The use of closed suction drains for treatment of acetabular fractures using a K-L approach is associated with increased rates of blood transfusion and increased length of hospital stay, with no impact on surgical site infection rates. The results of this study suggest against routine drain usage in acetabular surgery.

Short-term outcomes associated with drain use in shoulder arthroplasties: a prospective, randomized controlled trial

This study examined the immediate outcomes during the perioperative period associated with drains in the setting of total shoulder arthroplasty or reverse shoulder arthroplasty. We hypothesized that drain use would result in lower postoperative hemoglobin and hematocrit levels that would increase transfusion rates and longer hospital stays that would increase hospital costs. The study prospectively randomized 100 patients (55% women; average age, 69.3 years) who underwent total shoulder arthroplasty or reverse shoulder arthroplasty to receive a closed-suction drainage device (drain group, n = 50) or not (control group, n = 50) at the time of wound closure. Basic demographic information and intraoperative and postoperative data were collected. The groups were similar with respect to basic patient demographics. Postoperatively, drains had no effect on transfusion rates or any perioperative complication (P > .715). There were also no significant differences in hemoglobin or hematocrit levels immediately after surgery or on postoperative day 1. On average, patients were discharged from the hospital 1.6 days and 2.1 days postoperatively in the control and drain groups, respectively (P = .124). The average cost associated for the control cohort's hospital stay was $35,796 ± $13,078 compared with $43,219 ± $24,679 for the drain cohort (P = .063). Drain use after shoulder arthroplasty had no appreciable difference on short-term perioperative outcomes, postoperative anemia, length of hospital stay, or cost. It is possible that the potential negative effects of postoperative drainage are blunted by the routine use of tranexamic acid.

Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study.

BackgroundPostoperative suction drains are used after total knee arthroplasty to avoid intra-articular hematoma formation although they can increase blood loss due to a negative suction effect. The use of tranexamic acid to reduce blood loss may nullify this. The aim of this study was to compare outcomes in patients undergoing total knee arthroplasty with or without drains and to analyze whether the drain's diameter also has an impact.MethodsThis is a prospective randomized study of patients undergoing unilateral total knee arthroplasty performed by a single surgeon. The study population was divided into three groups (A, 10G drain; B, 12G drain; and C, no drain). Pain, blood loss, swelling, wound-related complications, functional outcomes and questionnaire-based outcomes were assessed postoperatively.ResultsEach group had 35 patients comparable in most demographic and pre- and intraoperative characteristics. During the first 6 hours postoperatively, opioid consumption was significantly higher when the drain was not used (p = 0.036). At 3 months postoperatively, new Knee Society Score (NKSS) was highest with the use of 12G drain (p = 0.018). However, NKSS at 1 year was comparable across the three groups. With the use of tranexamic acid, blood loss and incidence of soakage of dressing were unaffected by the presence or absence of a drain. The calf girth, suprapatellar girth, soakage of dressing and range of motion were comparable in all three groups. There was no incidence of surgical site infection or deep vein thrombosis.ConclusionsPresence of a suction drain significantly reduces opioid consumption during the first 6 hours after total knee arthroplasty. Use of a drain made no difference to the functional outcome at 1 year postoperatively. With the use of tranexamic acid in total knee arthroplasty, the total blood loss and the requirement of blood transfusion were unaffected by the presence or absence of closed suction drainage or by the bore of the drain used. The clinical parameters such as swelling, range of motion, infection and deep vein thrombosis also remained the same.

Assessment of Routine Drainage in Elective Thyroid Surgery. A Prospective Randomized Study

Background: At the end of thyroidectomy surgery, there was an area of some debate about insertion of closed suction drain before closure. The decision of routine use of drain depends on the surgeon’s training, experience, and personal preference. Many surgeons prefer to place drain to minimize dead space collection and to prevent or reduce the post-operative hematoma that may be life-threatening so, the insertion of drains was generally accepted, although there are many studies that show no difference in the rate of complication with or without drain insertion. Moreover drain insertion may be accompanied by many hazards such as more hospital stay and post-operative pain. So, the concept of routine use of drain should be revised in the light of recent reports that test the real need for its use. Aim of the study: this study aimed to assess if there was actual benefit from the use of drain in thyroid surgery and to evaluate the necessity of its use in thyroid surgery and to detect hazards of its use. Patients and methods: between June 2015 and July 2018, a prospective randomized study included 87 patients from those had elective thyroid surgery in Al-Hussien University Hospital for different indications. Patients had been categorized into 2 groups; group A (93 patients) for thyroidectomy without insertion of drain and group B (93 patients) for thyroidectomy with insertion of suction drain. In the study, results including: post-operative pain, hospital stay and complications (including wound infection, seromas, post-operative bleeding, hematoma, recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism) were documented. Follow up after patient discharge was done until healing of wounds to detect post-operative complications. Results: the overall postoperative complications rate in the study was low (13 patients) in the two groups. In the non-drained group, there were one case of hematoma ( 2.5 %), 2 cases of seroma ( 5.1 %), one case of RNL palsy ( 2.5 %), one case of transient hypoparathyroidism (2.5 %) and no cases of wound infection, whereas in the other group, there were 2 cases of hematoma ( 5.1 %), 3 cases of seroma ( 7.6 %), 2 case of RNL palsy ( 5.1 %), 2 case of transient hypoparathyroidism ( 5.1 %) and no cases of wound infection. There was no statistical significance between both groups as regard incidence of complications. In the non- drained group, 37 patients (94.8 %) were discharged at the next day after surgery while in the drained group 2 patients (5.1%) only were discharged in the next day and the remaining patients were discharged after removal of drain after 48 hours. The mean hospital stay for the non- drained group was 1.2±1 days and the mean hospital stay for the drained group was 2.1±1 days. Conclusion: in the study, use of drain in thyroid surgery did not have significant effect on the rate of incidence or prevention of postoperative complications. In serious postoperative bleeding, the drain which usually has small pores often become blocked be blood clots and become useless. On contrary, insertion of drain prolongs patient hospital stay and increases postoperative pain. So, routine use of drain in elective thyroid surgery should be prohibited.

Analysis of efficacy in postoperative use of closed suction drain in cases of traumatic dorsolumbar spine injury

Introduction: The use of closed suction drain has been controversial considering its utility in reducing infection and hematoma formation in the postoperative period. This study aims at analyzing the use of closed suction drain in patients of traumatic dorsolumbar spine injury managed by open posterior instrumentation. Materials and Methods: A total of 110 cases of traumatic spine injury with neurological deficit in the age group 18–65 years of either sex were included in this study. All the patients were managed by short-segment fixation without open decompression of the cord and without primary fusion. The use of closed suction drain in the postoperative period was randomized by randomized controlled trial table. Results: On comparing the difference between pre- and post-operative hemoglobin, C-reactive protein, visual analog scale, and duration of hospital stay, there was no statistically significant difference between the two groups. Conclusion: The use of closed suction drain in posterior instrumentation done for the cases of traumatic dorsolumbar spine injury within described parameters did not reduce postoperative wound infection, clinically significant hematoma formation or risk of further neurological injury.

A study to evaluate the factors influencing seroma formation after breast cancer surgery at tertiary care centre

Background: In the world, breast cancer is the most prevalent malignancy affecting women and stands second in cancer related deaths amongst women. Surgical intervention remains the main stay of treatment. Seroma formation is one of the predominant complications of breast cancer surgery, the cause remaining obscure and with multiple casual provenience. In view of this, we collected data to determine the factors related to incidence of seroma formation in our patients and increase its scope and hence attempt to contravene it.Methods: A retrospective study of 83 carcinoma breast patients who underwent breast cancer surgery from 1st January 2014 to 31st August 2018. Data regarding the following variables compared with age of the patient, BMI, neoadjuvant chemotherapy, tumor size, postoperative exercises/physiotherapy, use of cautery, number of lymph nodes removed, use of closed suction drainage, initial and 72hrs wound drainage. We used chi square and T test methods for statistical analysis of data in our study.Results: The overall seroma formation rate was estimated to be 27%. Factors identified to be significantly related to the formation of seroma are the following: age &gt;45 yrs, tumor size &gt;3cm, number of positive lymph nodes, BMI &gt;30 and total lymph nodes removed, type of surgery.Conclusions: To prevent seroma formation, it is important to identify individual risk factors of seroma formation i.e. the identification of predictive variables which will be vital in designing future trails aimed at reducing the incidence of this common complications of breast cancer surgery.

Management of late-onset deep surgical site infection after instrumented spinal surgery

BackgroundThere are no universally accepted protocols for the treatment of late-onset deep surgical site infection. This study retrospectively evaluates the methods of aggressive debridement with instrumentation retention, high vacuum closed-suction drain without irrigation, primary wound closure, and antibiotic therapy for the treatment of late-onset deep surgical site infection after instrumented spinal surgery.MethodsA total of 4057 patients who underwent instrumented spinal surgeries were surveyed from January 2010 to June 2014. Surgical debridement was performed immediately after late-onset deep surgical site infection was identified. In addition to extended resection of the devitalized and necrotic tissue, the biofilms adhered to the surface of implants were removed meticulously and thoroughly. Primary wound closure was performed on each patient, and closed suction drains were maintained for about 7–10 days without irrigation. Antibiotic therapy was administered for 3 months according to the results of the pathogenic culture.ResultsForty-two patients were identified as having late-onset deep surgical site infection. Staphylococcus aureus was the most common pathogen in this group. Seven patients with late-onset deep surgical site infection had negative bacterial culture results. Infections resolved in all patients. Forty-one patients retained their instrumentation, whereas 1 patient had the implants removed because of Staphylococcus aureus infection, which was found the implants loosening during debridement. Primary wound healing was found in all patients with no recurrence of infection during the follow-up periods.ConclusionsA timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are the keys to successfully resolving infection and keeping implants retention in the treatment of late-onset deep surgical site infection after instrumented spinal surgery.