Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis

Abstract

Purpose The clinical use of closed-suction drainage, which aims to reduce postoperative wound haematomas and infection, is common. This study was performed to determine whether closed-suction drainage is safe and effective in promoting wound healing and reducing blood loss and other complications compared with no-drainage in total hip arthroplasty. Methods The literature search was based on PubMed, the Cochrane Library, MEDLINE, and EMBASE. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group, and then analysed using RevMan 5.0. Twenty randomised controlled trials involving 3,186 patients were included in our analysis. Results The results of our meta-analysis indicate that closedsuction drainage reduces the requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference was observed in the incidence of infection, blood loss, changes in haemoglobin and haematocrit, functional assessment, or other complications when the drainage group was compared with the no-drainage group. Conclusions Our results of the comparison between closedsuction drainage and no drainage in THA have indicated that the routine use of closed-suction drainage for elective total hip arthroplasty may be of more harm than benefit.

Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study

“…However, there is some evidence that closed-suction drains in THA increase blood transfusion [32]. Johansson et al [33] found in a prospective, randomized controlled trial that wound compressions reduce wound discharge, and transfusion rates compared to drainage after THA.…”

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

“…However, CSD has been shown to be associated with increased blood loss by eliminating the tamponade effect produced by haematoma formation and may allow for retrograde dissemination of skin bacteria into the joint space [9]. A recent meta-analysis of 3,186 patients undergoing primary THA showed that the use of CSD increased the rate of blood transfusion and did not provide any benefits regarding to the incidence of infection, functional recovery or other complications [10].…”

Factors Predictive of Increased Surgical Drain Output After Anterior Cervical Discectomy and Fusion

“…3 For hip and knee arthroplasty, several studies have shown no difference in the incidence of infection, blood loss, changes in hemoglobin and hematocrit, functional assessment, or other complications when the drainage group was compared with the no-drain group. 4–8 In orthopaedic trauma studies, drains have also been found to be unnecessary. 9,10 …”