Postoperative Suction Drainage Research Articles

Efficacy of a Combined Intramedullary, Periarticular Injection, and Intraarticular Tranexamic Acid Application on Postoperative Bleeding in Total Knee Arthroplasty: A Retrospective Case-Matched Study.

Topical tranexamic acid (TXA) has been widely used to reduce postoperative blood loss following total knee replacement (TKA). This study aimed to evaluate the effect of combined intramedullary, periarticular injection, and intraarticular TXA application in patients who underwent TKA as compared to those who did not. This was a retrospective case-matched study of 111 patients. We evaluated the transfusion rate and postoperative drainage of 56 patients who underwent TKA using combined topical tranexamic acid application (directly pushed into the femoral intramedullary canal and tibia base, with periarticular soft tissue injection and injected into the knee cavity via a drain tube) and the control group of 55 patients. In the control and TXA groups, 7.14% and 1.81% of the patients received blood transfusions, respectively (p=0.176). The closed-suction drainage output at 0-8 h and total drainage output were significantly lower in the TXA group than those in the control group (p < 0.001). Application of topical TXA with the combined method (intramedullary, periarticular injection, and intraarticular) in TKA decreases postoperative suction drainage and may reduce the need for postoperative blood transfusion.

Preoperative clinical application of human fibrinogen in patients with acute Stanford type A aortic dissection: A single-center retrospective study.

To evaluate the perioperative clinical efficacy of preoperative human fibrinogen treatment in patients with acute Stanford type A aortic dissection (ATAAD). Data of 159 patients with ATAAD who underwent emergency surgical treatment in our hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether human fibrinogen was administered before surgery: patients in group A received fibrinogen before surgery, while those in group B did not. The preoperative clinical data, surgical data, postoperative data, complications related to the coagulation function, and mortality of the two groups were compared and analyzed. The in-hospital mortality was similar in the two groups (2.9% vs. 9.3%, p = .122). However, group A had a significantly shorter operation time (279.24 ± 39.03 vs. 298.24 ± 45.90, p = .008), lower intraoperative blood loss (240.48 ± 96.75 vs. 353.70 ± 189.80, p < .001), and reduced intraoperative transfusion requirement of red blood cells (2.61 ± 1.18 vs. 6.05 ± 1.86, p < .001). The postoperative suction drainage within 24 h in group A was significantly decreased (243.24 ± 201.52 vs. 504.22 ± 341.08, p = .002). The incidence of postoperative acute kidney injury (AKI) in group A was lower than that in group B (3.8% vs. 14.8%, p = .023). Similarly, the incidence of postoperative hepatic insufficiency in group A was lower than that in group B (1.9% vs. 9.3%, p = .045). In group A, the mechanical ventilation time was shorter (47.68 ± 28.61 vs. 118.21 ± 173.16, p = .004) along with reduced intensive care unit stay time (4.06 ± 1.18 vs. 8.09 ± 9.42, p = .003), and postoperative hospitalization days (19.20 ± 14.60 vs. 23.50 ± 7.56, p = .004). Preoperative administration of human fibrinogen in patients undergoing ATAAD surgery can effectively reduce the intraoperative blood loss, amount of blood transfused, operation time, and postoperative complications, and improve the early prognosis of patients. In addition, this procedure is highly safe.

Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles.

Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present. Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed. In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8-9 days (range: 1-30 days). The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate. · Suction drainage of lymphoceles is an easy and successful method to cure symptomatic lymphoceles at various locations.. · We believe this to be due to the induction of cavity collapse and surface adherence.. · In most cases rapid clinical improvement could be obtained.. · Franke M, Saager C, Kröger J et al. Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. Fortschr Röntgenstr 2022; 194: 384 - 390.

Efficacy of postoperative drainage after arthroscopic rotator cuff repair: a randomized controlled trial.

BackgroundArthroscopic rotator cuff repair is the standard treatment in patients with symptomatic reparable rotator cuff tear. It brings good to excellent postoperative outcomes. Postoperative suction drainage is the method to theoretically reduce postoperative shoulder swelling and hematoma formation, which is still commonly used in clinical practice, yet its efficacy remains unproven.MethodsThis is a nonblinded prospective randomized controlled study. A sample of 43 shoulders were simply randomized without replacement across drain and nondrain groups, allocated by sealed envelope before skin closures. The preoperative, intraoperative, and postoperative data were analyzed. The difference of oblique (O) and horizontal (H) shoulder circumference between before and after operation is the primary parameter indicating swelling and hematoma formation. The preoperative reliability of O and H dimensions were evaluated by 2 independent evaluators. The visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score were analyzed.ResultsThere was no significant difference of circumference between drain and nondrain groups in both O and H methods. For method O, the mean difference between drain and nondrain groups at 24 hours was -0.25 (95% CI: -2.09 to 1.59, P = .783), at 1 week was -0.54 (95% CI: -2.05 to 0.96, P = .470), at 1 month was -0.39 (95% CI: -2.06 to 1.28, P = .639) and at 3 months was -0.01 (95% CI: -1.49 to 1.46, P = .987). Method H: Mean difference between groups at 24 hours was 0.29 (95% confidence interval [CI]: -0.61 to 1.20, P = .520), at 1 week was 0.004 (95% CI: -0.99 to 1.002, P = .993), at 1 month was -0.53 (95% CI: -1.62 to 0.56, P = .333), and at 3 months was -0.07 (95% CI: -0.91 to 0.77, P = .862). The preoperative O and H parameters showed strong to almost perfect agreement (intraclass correlation coefficient for A = 0.858 [95% CI: 0.738 to 0.923, P < .001], intraclass correlation coefficient for B = 0.955 [95% CI: 0.918 to 0.976, P < .001]). No significant difference of visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score was recorded between groups.ConclusionNo difference was found between drain and nondrain placement for shoulder swelling, visual analog scale, estimated blood loss, and functional outcome in 3 months after surgery. Drain placement after arthroscopic rotator cuff repair is of unproven benefit in routine clinical practice.

The clinical applied analysis of the modified transoral endoscopic thyroidectomy vestibular approach

Objective: To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice. Methods: Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized. Results: Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury. Conclusion: The modified TOETVA by dissection of mental nerve is safe and feasible.

A comparative study of onlay &amp; sublay mesh repair of ventral wall hernias in a tertiary care research centre

Introduction: Ventral hernia is common in abdominal surgeries and is an important source of morbidity and mortality. Range of surgical techniques has been developed, from suturing techniques to various types of mesh repair. Mesh repair technique has shown a less number of postoperative complications and recurrence compared with other techniques. The bed on which mesh is placed is still debated. Among which one type being onlay and other being sublay are widely used but outcome of both is still controversial and do depend on surgeon’s choice of procedure. The purpose of this study was to compare the traditional on?lay mesh and sublay mesh placement in ventral hernia repairs in terms of time taken for surgery, duration of post-operative drainage, early and delayed complications. Materials and Methods: This is a prospective study which was conducted in the surgical department Navodaya Medical college hospital and research centre. A total of 50 cases in 1 years of duration were studied. Of these cases, 25 cases were managed by the on?lay mesh method and 25 by sublay mesh placement. Results: Operative time for sublay mesh placement was significantly higher than on?lay mesh repair, whereas, the duration of post-operative suction drainage was significantly lower in case of the sublay group. Superficial surgical site infection and seroma formation were statistically insignificant in both the study groups, although lesser in the sublay group. The recurrence rate was found to be 11% in on?lay mesh repair and 7% in sublay (retro rectus) mesh repair. Conclusions: Sublay mesh repair seems to be better method than onlay repair in duration of the post-operative suction drainage. In the sublay mesh repair group lower rate of complications and recurrence were seen. Keywords: Onlay, Sublay, Mesh Repair, Ventral hernias.

Superomedial pedicle reduction mammaplasty with and without drains: a comparative analysis

Background: Postoperative suction drainage following reduction mammaplasty are purported to reduce complications such as haematoma, seroma, delayed wound healing and loss of nipple or areola. The aim of this study is to compare the complication profile of breast reduction surgery patients who received postoperative drains and those who did not.&#x0D; Methods: A retrospective analysis of 172 patients over the period January 2011 to June 2017 were identified. Statistical analysis with regression modelling was used to compare the complication profile between patients who had and had not received postoperative drainage.&#x0D; Results: Patients were divided between ‘drained’ (n=86) and ‘drainless’ (n=86) cohorts with no significant difference in age, smoking and diabetic status between the two groups (p&gt;0.05). Mean body mass index (BMI) was significantly higher in the drained group (29.0) compared to 25.7 in the drainless cohort (p&lt;0.05). Patients in the drained group also had a significantly higher breast weight reduction (660g compared to 536g, p&lt;0.05). There was significantly more vertical skin resection patterns in the drained group (n=25 or 29.1%) compared to the drainless group (n=8 or 9.3%) (with p=0.001). Using multivariate logistic regression, drains resulted in a slightly lower risk for complications but this difference was not statistically significant (OR 0.84; 95% CI=0.39-1.81; p=0.66). However, BMI was strongly associated with complications (p=0.007).&#x0D; Conclusions: Our results support the contention that routine postoperative drain insertion in reduction mammaplasty does not significantly reduce complications irrespective of the patient’s BMI, breast tissue reduction weight, use of liposuction or skin resection pattern.

Self-made thoracic needled suspending device with a snare: An excellent aid for uniportal video-assisted thoracic lobectomy and segmentectomy for lung cancer.

Safety and feasibility of the self-made thoracic needled suspending device with a snare in the uniportal video-assisted thoracic lobectomy and segmentectomy for the treatment of non-small cell lung cancer were explored. In total, 80 pulmonary lung major resections (including lobectomy and segmental resections) with systematic mediastinal lymphadenectomy were retrospectively analyzed. Patients were randomly divided into an observation group and a control group. In the observation group, the device was used to hang affected lungs, left and right vagus nerve at the level of tracheal bifurcation, the arch of azygos vein, left phrenic nerve and left and right bronchus on the chest wall to offer a better exposure of the operation field. In the control group, the conventional uniportal video-assisted thoracic surgery was performed without using the self-made device. Systematic mediastinal lymphadenectomy was performed in both groups. Operation time, intraoperative blood loss, postoperative extubation time, hospital stay and perioperative complications in the early stage of patients in both groups were compared. The operation time 120.2±40.32 min, intraoperative blood loss 100.51±50.23 ml, and postoperative suction drainage volume 208±97.56 ml/day in the observation group were significantly different from those in the control group (P<0.05), and there were no significant differences in postoperative extubation time, hospital stay and perioperative complications between the two groups (P>0.05). The self-made thoracic needled suspending device with a snare is an excellent helper for uniportal video-assisted thoracic surgery, because it helps to expose surgical field and has no postoperative cicatrisation at puncture point on the wall of the chest. The device and its use are worthy of promotion.

A comparative study of on-lay and sub-lay mesh repair of ventral wall hernias in a tertiary health care centre

Background: Ventral hernia is a common occurrence in abdominal surgeries and an important source of morbidity. A wide spectrum of surgical techniques have been developed, ranging from suturing techniques to various types of prosthetic mesh repair. Use of mesh repair technique showed a reduced number of postoperative complications and recurrence compared with other techniques. The exact technique of mesh repair is still debated. The purpose of this study was to compare the traditional on‑lay mesh and sublay mesh placement in ventral hernia repairs in terms of time taken for surgery, duration of drainage after surgery, early complication and delayed complications.Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on‑lay mesh method and 25 by sublay mesh placement.Results: The operative time for sublay mesh placement was significantly higher than that of on‑lay mesh repair, whereas, the duration of post-operative suction drainage was significantly lower in case of the sublay group. Occurrence of complications like superficial surgical site infection and seroma formation were statistically insignificant in both the study groups, although frequency of complications was lesser in the sublay group. The recurrence rate was found to be 12% in on‑lay mesh repair and 8%in sublay(retro‑rectus) mesh repair.Conclusions: Sublay mesh repair is a better method than onlay repair with respect to the duration of the post-operative suction drainage. A lower rate of complications and a lower rate of recurrence was seen in the sublay mesh repair group.

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty.

The combined (IV (intravenous) + topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral + topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral + topical use is as safe and efficient as the IV + topical use, in addition to the main advantage of relatively low cost. In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral + topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 ( p < 0.05) in favour of the combined group. The post-operative drainage amounts ( p = 0.0001), measured blood loss volume ( p = 0.003) and transfusion rates ( p = 0.03) were lower in the combined (oral + topical) group compared to the topical group. Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.

The use of postoperative suction drainage in total knee arthroplasty: a systematic review.

The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA. Six randomised controlled trials were included. There is no significant difference between the individuals who receive a drain and those who do not across any of the measures examined (p < 0.05). This analysis demonstrates no statistical difference in ROM [mean difference 0.03° (95 %CI -1.51 to 1.45, p = 0.64, I(2) = 0 %)]. , nor in knee circumference [mean difference 1.63 cm (95 % CI -1.07 - 4.34 cm, p = 0.34), [I(2) = 0.12]. The finding raises the possibility that drains are not required to assist in recovery following TKA.

No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties

Purpose Posterior-cruciate-ligament-retaining (PCR) and posterior-cruciate-ligament-stabilized (PS) arthroplasties are two major common practices in total knee arthroplasty (TKA). The hypothesis of the present study was that compared with the PCR technique, the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA.MethodsIn this prospective, randomized study, 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group (Group I) or the PS group (Group II). The exclusion criteria were rheumatological joint disease, previous knee surgery, anticoagulant therapy and hypertension. There were no significant differences in age, body mass index and gender, between the groups. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1, 3 and 5. The postoperative suction drainage and blood transfusion volumes were also recorded.ResultsThere were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1, 3 and 5. There were also no statistically significant differences in the total measured blood loss volume, postoperative drainage amounts or transfusion rates between the groups.ConclusionUse of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general. The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA.Level of evidenceI.

The Influence of Femoral Cementing on Perioperative Blood Loss in Total Knee Arthroplasty

Total knee arthroplasty can involve substantial blood loss. We prospectively studied a consecutive series of patients undergoing primary total knee arthroplasty to assess the influence of femoral cementing on perioperative blood loss. We hypothesized that an uncemented femoral component is a risk factor for bleeding. A semiconstrained posterior stabilized prosthesis was used in all patients. Preoperatively, 130 patients were randomly assigned to either the cement group (Group 1) or the hybrid group (Group 2). We selected all patients who underwent a knee replacement through a medial parapatellar approach (n = 107). Group 1 consisted of forty-two women and twelve men ranging in age from fifty-six to eighty-five years. Group 2 consisted of thirty-seven women and sixteen men ranging in age from fifty-six to eighty-five years. The hemoglobin and hematocrit levels were recorded preoperatively and five days postoperatively for each patient. The volumes of postoperative suction drainage and the rate of blood transfusion were recorded. No differences between the two groups were identified with regard to hemoglobin and hematocrit levels, total measured blood loss, postoperative drainage amounts, or transfusion rates. The total measured blood loss was 1758.9 mL for Group 1 and 1759 mL for Group 2. Cementing the femoral component during a total knee arthroplasty does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion.

Role of Amicar in Surgery for Neuromuscular Scoliosis

A retrospective case-control study. Evaluate the effectiveness of Amicar in decreasing perioperative blood loss in patients with neuromuscular scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI). Previously, a preliminary prospective; prospective randomized double-blind; same-day anterior and posterior spinal fusion; and fibrinogen studies have demonstrated Amicar to be effective in decreasing total perioperative blood loss and transfusion requirements in surgery for idiopathic scoliosis. Increased fibrinogen secretion is a possible explanation. We are now analyzing its effectiveness in neuromuscular scoliosis. Amicar was administered at 100 mg/kg over 15 minute not to exceed 5 g after anesthesia induction. Maintenance is 10 mg/kg/h until wound closure. There were 2 study groups: group 1 (n = 34), no Amicar and group 2 (n = 62) who received Amicar. The majority of patients in both groups had cerebral palsy. Total perioperative blood loss was determined from the estimated intraoperative blood loss and measured postoperative suction drainage. Total perioperative blood loss and transfusion requirements (cell saver and allogeneic) were compared using chi or Fisher exact test. There was statistically less estimated intraoperative blood loss, total perioperative blood loss, and transfusion requirements in group 2. Postoperative suction drainage was also less but did not reach statistical significance. In group 1, estimated intraoperative blood loss, measured postoperative suction drainage, and total perioperative blood loss were 2194 +/- 1626 mL, 903 +/- 547 mL, and 3055 +/- 1852 mL, whereas in group 2, it was 1125 +/- 715 mL, 695 +/- 489 mL, and 1805 +/- 940 mL. Transfusion requirements were 1548 +/- 962 mL in group 1 but only 660 +/- 589 mL in group 2 (P < 0.0001). Amicar was equally effective in all diagnoses. There were no complications related to the use of Amicar. Amicar was highly effective in decreasing perioperative blood loss and transfusion requirements in patients with neuromuscular scoliosis undergoing PSF and SSI. It was most effective in decreasing estimated intraoperative blood loss. This results in decreased transfusion requirements, costs, and potential transfusion-related complications.

Fibrinogen Levels Following Amicar in Surgery for Idiopathic Scoliosis

Prospective evaluation of fibrinogen levels before surgery and after surgery in patients with idiopathic scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI) who received Amicar to decrease perioperative blood loss. To assess a possible association between postoperative fibrinogen levels and Amicar administration. Our previous randomized, double-blind (Amicar and control) study demonstrated a rise in fibrinogen levels on the first postoperative day in the Amicar group, but not in the control group. Fibrinogen levels were not measured on the remaining postoperative days. We subsequently measured fibrinogen levels on all postoperative days in 21 consecutive patients with idiopathic scoliosis and found a dramatic increase throughout the postoperative hospitalization. This study is a continuation of our analysis of postoperative fibrinogen levels. We analyzed fibrinogen levels before surgery and on all postoperative days (4 or 5 days) until discharge in 51 consecutive patients, including our 21 previously reported patients, who received Amicar and underwent a PSF and SSI. We also analyzed the same factors with respect to perioperative blood loss as in our previous Amicar studies. There were 41 females and 10 males with a mean age at surgery of 14.2 +/- 1.8 years. Their mean hospitalization was 4.6 +/- 0.8 days. Their mean estimated intraoperative blood loss was 766 +/- 308 mL and postoperative suction drainage 532 +/- 186 mL for a total perioperative blood loss of 1297 +/- 311 mL. The perioperative transfusion requirements were 0.5 +/- 0.6 U per patient. The preoperative fibrinogen was 255.5 +/- 58.3 mg/dL, and it rose steadily throughout the postoperative period to 680.9 +/- 111.9 mg/dL on the fifth postoperative day. There were no complications related to the use of Amicar. Fibrinogen levels rise steadily throughout the postoperative period. The significance of this increase is unknown. Was it due to the use of Amicar or just the effects of surgery itself? Further investigations will be necessary.

Effect of Drain Pressure in Total Knee Arthroplasty

To study the effect of drain suction pressure on drainage volume, decrease in haemoglobin level, blood transfusion, and wound complications following total knee arthroplasty. Primary total knee arthroplasty for degenerative osteoarthritis was performed in 60 (49 female and 11 male) patients. Patients were randomised for high-pressure (600 mm Hg) or low-pressure (350 mm Hg) postoperative suction drainage. Drain output was recorded daily and the drain removed after 48 hours. Postoperative haemoglobin level was measured on the evening of the operation day and on postoperative day 2. The high-pressure group had a significantly higher drainage volume and decrease in haemogloblin level than the low-pressure group. However, there was no significant difference between groups in the transfusion rate, number of units of blood transfused, wound discharge, or Knee Society knee and function scores. No wound infection was detected in any patient. CONCLUSION. Low-pressure suction drainage results in less blood loss without a significant increase in wound complications.

Monitoring Method for Deep Infection after TKA: Significance of Intraoperative Synovial Fluid Culture and Postoperative Suction Drainage Tip Culture

Purpose : The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. Materials and Methods : Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. Results : 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). Conclusion : In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.

Monitoring for Deep Wound Infection after Thoracolumbar Surgery Significance of Suction Drainage Tip Culture for Early Detection of Postoperative Deep Wound Infection

Study Design: A retrospective study. Objectives: To evaluate the usefulness of postoperative suction drainage tip cultures as a method of predicting the development of deep wound infections after thoracolumbar surgery using pedicle screws. Summary of Literature Review : The primary diagnostic elements of post-operative spinal infections are a high degree of clinical suspicion by the surgeon combined with aspiration and culture of the suspected infection sites. Materials and Methods : We analyzed the results of cultures on postoperative suction drainage tips from a total of 471 thoracolumbar surgery cases. We calculated the sensitivity, specificity, and predictive value and investigated the isolated pathogens. In addition, we performed quantitative analyses of serum C-reactive protein using Turbidimetry. Results: The post-operative infection rate was 4.0%. The most common isolated pathogen of the true positive cases was staphylococcus aureus, which was found in 3 cases (methicillin-resistant staphylococcus aureus in 2 cases); and that of the false positive cases was coagulase-negative staphylococcus in 5 cases. The sensitivity of the suction drainage tip culture was 52.6%, the specificity was 96.3%, the positive predictive value was 37.0%, and the negative predictive value was 98.0%. In cases of C-reactive protein, true positive and false negative cases followed the same course, where the CRP decreased slowly for the first week but remained elevated persistently at the 14th postoperative day. Conclusions: Culture of the suction drainage tips could not predict the development of postoperative deep wound infections, but it had more significance in the exclusion of deep wound infections. We concluded that careful observation for other signs of deep wound infections are necessary when a clinically significant pathogens are isolated.

The Role of Amicar in Decreasing Perioperative Blood Loss in Idiopathic Scoliosis

Four separate studies on the role of Amicar in decreasing perioperative blood loss in idiopathic scoliosis. To assess the efficacy and possible mechanisms of action for Amicar. Preliminary prospective, randomized double-blind and analysis of same-day anterior spinal fusion (ASF), fibrinogen, and posterior spinal fusion (PSF) studies have demonstrated Amicar to be effective in idiopathic scoliosis surgery. Increased fibrinogen secretion is a possible explanation. Amicar is administered at 100 mg/kg over 15 minutes not to exceed 5 g at anesthesia induction. Maintenance is 10 mg/kg per hour until wound closure. Preliminary study: Amicar (N = 28) was effective compared with a control group (N = 31). Perioperative blood loss and transfusion following PSF were 1,604 +/- 517 mL and 1.1 +/- 1.0 U in the Amicar group compared with 2,312 +/- 994 mL and 2.1 +/- 1.1 U in the control group (P < 0.003). Prospective, randomized double-blind study confirmed this efficacy, although primarily in postoperative suction drainage: 1,391 +/- 212 mL and 1.1 +/- 1.0 U compared with 1,716 +/- 513 mL and 2.1 +/- 1.3 U (P < 0.002). A fibrinogen study (N = 21) demonstrated steady and excessive increase following PSF: before surgery it was 266 +/- 63 mg/dL and on the fifth postoperative day 699 +/- 94 mg/dL. In same-day anterior and posterior spinal surgery, Amicar was again effective, but primarily in decreasing chest tube drainage and during PSF. Group 1 (N = 15, no Amicar) 3,807 +/- 105 mL and 3.1 +/- 1.5 U; Group 2 (N = 27, Amicar for PSF only) 2,080 +/- 659 mL and 1.9 +/- 0.9 U; and Group 3 (N = 16, both ASF and PSF) 2,183 +/- 851 mL and 1.0 +/- 0.8 U. Amicar appears highly effective in decreasing perioperative blood loss. This results in less autologous blood donation, blood transfusion, costs, and complications. Its mechanism of action is uncertain but may be related to increased fibrinogen secretion.

Proper Timing of Breast Reduction During the Menstrual Cycle

Breasts are known to show cyclic changes in accordance with the menstrual cycle, and speculations have been made regarding the ideal timing of breast surgery in this extent, but the clinical evidence to support global acceptance and application is lacking. This study was designed to establish the relationship of intraoperative bleeding and postoperative drainage with the menstrual period of 35 reduction mammaplasty patients. The results indicate that both perioperative blood loss and postoperative drainage were significantly reduced when breast reduction is performed during the periovulatory phase compared with the perimenstrual phase. The authors strongly recommend the interval between days 8 and 20 of the menstrual cycle as a more convenient period to perform breast reduction. Drains may be avoided during this period, but they are preferred if the surgery is done during the perimenstrual phase.