A systematic review and meta-analysis of wound drains in non-instrumented lumbar decompression surgery

Davidoff, Christopher L.; Rogers, Jeffrey M.; Simons, Mary; Davidson, Andrew

doi:10.1016/j.jocn.2018.04.038

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…Fresh blood clots may even impede the functionality of drains, with persistent subgaleal fluid collections. In the context of spine surgery or orthopedic operations, placement of drains does not seem to prevent postoperative epidural bleeding and overall infection rate, though an increase in patient discomfort is noted [14,38,45,54]. After abdominal surgery (laparotomy), Higson et al found a duplication of infection using non-aspirating drainage, whereas other studies did not confirm this association [25].…”

Section: Possible Complications and Side Effects After Placement Of Smentioning

confidence: 99%

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

et al. 2020

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Background For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. Method We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. Results Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). Conclusions Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.

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Section: Possible Complications and Side Effects After Placement Of Smentioning

confidence: 99%

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

et al. 2020

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“…Another possibility is that surgeons who routinely use drains may not use them when there is a dural tear, which could increase the chance of an epidural hematoma forming if drains are proven to be effective in their prevention. Wound drains, which are typically used to prevent the development of symptomatic epidural hematomas following spine surgery, are a controversial topic and unfortunately not covered in the NSQIP database [10]. The use of drains following spinal decompressions should be further explored.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Knusel

Ren

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Symptomatic post-operative lumbar epidural hematoma (PLEH) is a complication of lumbar spine surgery that can cause permanent neurologic consequences through compression of the cauda equina and nerve roots. Questions/Purposes: We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas. Methods: Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30 days for symptomatic PLEH included demographics, comor-bidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications. Results: There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% (n = 206), 54.4% (n = 112) of which occurred within 5 days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection. Conclusions: Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.

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“…20 Postoperative Drains While there is a paucity of literature supporting their role in reducing rates of SPEH, postoperative drains are widely used in spine surgery. 11,21 In a prospective study of 50 randomized patients, Mirzai et al 1 reported that the use of postoperative subfascial lumbar drains decreased the volume of asymptomatic epidural hematomas seen on MRI scans obtained postoperatively when compared with those without drains. Other reports have suggested that decreased output in a malfunctioning drain can be a risk factor of SPEH.…”

Section: Coagulopathymentioning

confidence: 99%

Postoperative Spinal Hematoma and Seroma

Butler

Mohile

Phillips

2023

J Am Acad Orthop Surg

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Fluid collections after spine surgery are rare complications, although potentially grave, and may be broadly grouped into two major categories. Symptomatic postoperative epidural hematomas have some known risk factors and can present with a widely variable profile of signs and symptoms. Treatment involves emergent surgical evacuation to reduce the risk of permanent neurologic deficit. Postoperative seroma may lead to disruption of wound healing and deep infection and has been associated with the use of recombinant human bone mineral protein. These diagnoses may present diagnostic challenges; thorough understanding of the involved pathophysiology, meticulous clinical evaluation, and radiographic interpretation are critical to appropriate management and optimal outcome.

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A systematic review and meta-analysis of wound drains in non-instrumented lumbar decompression surgery

Cited by 15 publications

References 33 publications

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Postoperative Spinal Hematoma and Seroma

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