Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

Abstract

CitationErickson BJ, Campbell K, Jain A, et al. Are post-operative drains beneficial in total and reverse total shoulder arthroplasty?. ABSTRACTBackground: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are effective treatments for glenohumeral arthritis and rotator cuff arthropathy. Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications. Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA. Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed. Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003). Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage. LEVEL OF EVIDENCE: III: case-control study.

The 50 most-cited articles in reverse shoulder arthroplasty

“…39,45,48,53 However, it has since been shown that drains provide may provide limited benefit and actually increase complications. 89 Lastly, indications are constantly expanding, and occasionally contracting, for various procedures in orthopedic surgery, and we feel it should be noted that RTSA is no longer reserved for those >70 years of age, as some of the top 50 articles recommend. 2,44,45 Similar to sentiments expressed by Namdari et al, we believe quantifying the top 50 most-cited articles in RTSA can provide orthopedists, from new residents to experienced attending shoulder surgeons, with a helpful "short-list" of articles that can orient the reader to the current status and evolution of the body of RTSA literature.…”

“…39,45,48,53 However, it has since been shown that drains provide may provide limited benefit and actually increase complications. 89 Lastly, indications are constantly expanding, and occasionally contracting, for various procedures in orthopedic surgery, and we feel it should be noted that RTSA is no longer reserved for those >70 years of age, as some of the top 50 articles recommend. 2,44,45…”

Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

“…The use of drains in total joint arthroplasty has been heavily examined in hip and knee replacements; however, there is a paucity of literature examining effects of drains in shoulder arthroplasty. A study by Erickson et al 10 compared patients who underwent TSA and RTSA with and without a closed suction drain, finding that patients who received closed suction had a greater hemoglobin loss. However, the authors did not compare the extent of blood loss between TSA and RTSA.…”