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

Abstract

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.

A Novel Wound and Soft Tissue Flap Negative Pressure Drain System - a Pilot Study

“…In recent years, routine drain use has fallen out of favor, as meta-analyses have shown questionable benefits in wound healing, and at times, increased rates of contamination and infection [20,22]. Recent arthroplasty literature has also shown increased rates of hospital length-of-stay with routine drain use when compared to no drain [17,27]. While wide tumor resection and extensive debridement for infection differ greatly from primary arthroplasty, the repercussions of drain use should still be considered highly before placement in any patient.…”

The role of suction drainage in the management of peri-operative bleeding in Total and Unicompartmental knee arthroplasty: a retrospective comparative study

“…Specifically, total knee arthroplasty (TKA) is commonly considered one of the most effective orthopedic procedure in the treatment of end-stage knee OA and various rheumatic diseases such as rheumatoid arthritis, leading to substantial pain relief and functional improvement [ 1 ]. Besides, unicompartmental knee arthroplasty (UKA) represents a viable alternative in the treatment of unicompartmental knee OA showing a lower morbidity [ 3 , 4 ]. Nevertheless, since knee arthroplasty involves soft tissue and bone dissection, several perioperative complications can be observed [ 5 ].…”

“…Although TKA usually shows a higher bleeding rate, UKAs may also have the aforementioned complications [ 2 ]. Even if it is a common belief that intra-articular suction drainage may reduce local hematoma, leading to swelling decrease, surgical wound healing improvement and reduction of postoperative infection rate [ 3 , 4 ], drain use is likely to be associated with an increased risk of blood transfusion due to the lack of tamponade effect [ 1 ]. In Fast-track (FT) programs early drainage removal is recommended [ 4 , 5 ].…”

Risk of stroke after unilateral or bilateral TKA (simultaneous and staged without discharge) in 327,438 matched patients using data from the National Health Insurance Claims for South Korea

“…Total knee arthroplasty (TKA) is the most e cacious and successful treatment for advanced osteoarthritis (OA) of the knee. [1,2] However, 23% of patients scheduled for unilateral TKA show severe symptoms in the contralateral knee and 93% of patients required a contralateral TKA within 5 years of index surgery. [3] Moreover, unilateral deformity correction for patients with severe deformities creates asymmetric lower limb alignment that can signi cantly affect rehabilitation.…”