Closed-suction drainage in thoracolumbar spinal surgery–clinical routine without evidence? a systematic review

Abstract

Purpose The considered benefit of surgical drain use after spinal surgery is to prevent local accumulation of a haematoma by decompressing the closed space in the approach of the surgical site. In this context, the aim of the present systematic review was to prove the benefit of the routine use of closed-suction drains. Methods We conducted a comprehensive systematic review of the literature according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and algorithm. Results Following the literature search, 401 potentially eligible investigations were identified. Eventually, a total of 24 studies with 8579 participants were included. Negative suction drainage led to a significantly higher volume of drainage fluid. Drainage duration longer than 72 h may be associated with a higher incidence of Surgical side infections (SSI); however, accompanying antibiotic treatment is unnecessary. Regarding postoperative haematoma and neurological complications, no evidence exists concerning their prevention. Hospital stay length and related costs may be elevated in patients with drainage but appear to depend on surgery type. Conclusions With regard to the existing literature, the use of closed-suction drainage in elective thoracolumbar spinal surgery is not associated with any proven benefit for patients and cannot decrease postoperative complications.

Postoperatives Drainage- und Wundmanagement nach Wirbelsäuleneingriffen

“…Aus ökonomischer Sicht scheint der Einsatz von Drainagen keine Auswirkungen zu haben. Keine der publizierten Arbeiten fand eine längere Verweildauer oder erhöhte Kosten im einen oder anderen Kollektiv [7].…”

“…In ihrer randomisierte Kontrollstudie mit insgesamt 155 Patienten kam es sowohl im Kollektiv mit wie auch ohne Drainage zu lediglich einer oberflächlichen Wundinfektiontiefer gehende Infektionen wurden nicht beobachtet [10]. Ähnlich auch die Ergebnisse anderer Untersuchungen im Rahmen von dorsalen Fusionsoperationen [7].…”

“…Generell ist die Evidenz über den Einsatz von Wunddraingen sowie das optimale postoperative Wundmanagement allerdings mäßig, wie im Rahmen einer systematischen Literaturrecherche von uns dargestellt werden konnte [7]. So beruht die Entscheidung, ob eine Drainage verwendet, wo sind platziert oder ob ein Unterdruck angelegt wird meist auf der Einschät-zung und dem Ermessen des behandelnden Chirurgen, ein definitiver Konsensus fehlt.…”

Complications associated to wound drainages in tumor spine surgery: a multicenter surveillance study from the German Spine Registry (DWG-Register)

“…Surgical treatment of spine tumors is an important, growing but interdisciplinary challenging field of orthopedic surgery and neurosurgery. There is an ongoing debate whether a surgical drainage is beneficial to prevent local accumulation of hematoma and to reduce the rate of wound infections, and neurological deficits 1 , 2 . There is only limited evidence whether patients profit from wound drainage after spine tumor surgeries and if the postoperative complication rate is lower if a drainage is placed.…”

Answer to the letter to the editor of M. Kataria et al. concerning "Local vancomycin therapy to reduce surgical site infection in adult spine surgery: a randomized prospective study" by Salimi S, et al. (Eur Spine J [2022];31:454–460)

“…There is doubt about the effect of negative suction drainage after spinal surgery [5]. We kept the negative suction drain for 24 h after the surgery, and if the drainage was high, the drain was kept under vacuum conditions for a maximum of 48 h, except for 8 cases of CSF leak that there was CSF in drain, in which the drain was kept for the second 24 h without vacuum.…”