Post-operative drain use in patients undergoing decompression and fusion: incidence of complications and symptomatic hematoma

Adogwa, Owoicho; Elsamadicy, Aladine A.; Sergesketter, Amanda R.; Shammas, Ronnie L.; Vatsia, Sohrab; Vuong, Victoria D.; Khalid, Syed I.; Cheng, Joseph; Bagley, Carlos A.; Karikari, Isaac O.

doi:10.21037/jss.2018.05.09

Cited by 28 publications

(30 citation statements)

References 39 publications

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“…24 , though stated as a RCT, is a cohort study by described methodology and thus assessed as such. Of the cohort studies, 26 (81.2%) were retrospective 9,[13][14][15]17,20,22,23,[25][26][27][29][30][31][33][34][35][36][37][38]40,41,44,46,47,49 , 3 (9.4%) were prospective 16,21,24 , and 3 (9.4%) was ambispective 12,43,48 in study design. The number of patients in included RCTs ranged from 30 to 326 (Median: 155), whilst that in cohort studies ranged from 42 to 10,225 (Median: 265.5).…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…The number of patients in included RCTs ranged from 30 to 326 (Median: 155), whilst that in cohort studies ranged from 42 to 10,225 (Median: 265.5). 17 of 30 12,15,18,21,22,[24][25][26]31,32,35,40,42,43,45,47,48 There is insufficient evidence to provide recommendations on postoperative AMP administration to reduce the rate of SSI in other types of spine surgery.…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…Both supra-fascial and sub-fascial wound drainage were included without sub-group analysis according to location of drain. The evidence for this comparison is derived from 5 RCTs 10,11,28,39,45 and 8 OBS 13,23,29,30,33,40,44,49 .…”

Section: Q2b What Is the Minimum Duration That Dressings For Uncomplmentioning

confidence: 99%

“…High quality evidence at the outcome level suggested no difference in rate of SSI when wound drainage systems were used. This was based on a meta-analysis (N=2443) of twelve studies 10,11,13,23,[28][29][30]33,39,40,44,45 which found no significant difference in rate of SSI (RD=0.001, 95% CI -0.006 to 0.007, p-0.844). Further sub-group meta-analyses of adult patients undergoing decompression-only lumbosacral surgery (5 studies 11,28,29,44,50 , N=950), and of adult patients undergoing lumbosacral fusion surgery (4 studies 11,33,40,45 , N=643), and patients with adolescent idiopathic scoliosis (2 studies 10,13 , N=530) similarly demonstrates no significant differences in the rate of SSI when wound drainage is used postoperatively.…”

Section: Q2b What Is the Minimum Duration That Dressings For Uncomplmentioning

confidence: 99%

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Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary

et al. 2020

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There are three phases in prophylaxis of surgical site infections (SSI): preoperative, intraoperative and postoperative. There is lack of consensus and paucity of evidence with SSI prophylaxis in the postoperative period. The authors systematically evaluate the literature, and provide evidencebased recommendations on postoperative measures for SSI prophylaxis in spine surgery. Methods A systematic review conforming to PRIMSA guidelines was performed utilizing PubMed (MEDLINE), EMBASE, and the Cochrane Database from inception to January 2019. The GRADE approach was used for quality appraisal and formulation of recommendation. Six postoperative care domains with associated key questions were identified. Included studies were extracted into evidence tables, data synthesized quantitatively and qualitatively, and evidence appraised per GRADE approach. Results Forty-one studies (9 RCT, 32 cohort studies) were included. In the setting of standard-of-care preincisional antimicrobial prophylaxis (AMP) administration, the use of postoperative AMP for SSI reduction is not necessary in decompression-only or lumbar spine fusion surgery. Prolonged administration of AMP for more than 48h postoperatively does not seem to reduce rate of SSI in decompression-only or lumbar spine fusion surgery. Utilization of wound drainage systems in lumbosacral spine and adolescent idiopathic scoliosis corrective surgery does not seem to alter the overall rate of SSI in spine surgery. Concomitant administration of AMP in the presence of a wound drain does not seem to reduce the overall rate of SSI, deep SSI, or superficial SSI in thoracolumbar fusion performed for degenerative and deformity spine pathologies, and in adolescent idiopathic scoliosis corrective surgery. Enhanced-recovery after surgery (ERAS) clinical pathways and infectionspecific protocols does not seem to reduce rate of SSI in spine surgery. There is insufficient evidence to provide recommendations on all other types of spine surgeries with respect to their respective indications and postoperative SSI prophylactic measures. This also includes other non-AMP pharmacological measures, dressing type & duration, suture & staples management and postoperative nutrition for SSI prophylaxis in spine surgery. Conclusion Despite the postoperative period being key in SSI prophylaxis, the literature is sparse and without consensus on optimum postoperative care for SSI prevention in spine surgery. The current best

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Section: General Study Characteristicsmentioning

confidence: 99%

Section: General Study Characteristicsmentioning

confidence: 99%

Section: Q2b What Is the Minimum Duration That Dressings For Uncomplmentioning

confidence: 99%

Section: Q2b What Is the Minimum Duration That Dressings For Uncomplmentioning

confidence: 99%

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Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary

et al. 2020

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“…In line with the above-mentioned results, Adogwa et al concluded that the use of drains was not associated with a reduction of SSIs in patients undergoing spinal decompression and fusion [18]. In a retrospective clinical study of 133 patients who underwent primary spinal surgery (37 laminoplasties, 16 decompressions, 80 fusions), there was no significant association between drain tip culture and drainage duration, or between the rate of SSI and drainage duration [19].…”

Section: Duration Of Treatment With Suction Drainagementioning

confidence: 84%

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

Schnake

Pumberger

Rapper³

et al. 2022

Eur Spine J

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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.

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Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

et al. 2020

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Post-operative drain use in patients undergoing decompression and fusion: incidence of complications and symptomatic hematoma

Abstract: Our study suggests that the use of postoperative subfascial drains in patients undergoing spinal decompression with fusion may not be associated with a reduction in SSIs or hematoma formation.

Cited by 28 publications

References 39 publications

Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary

Prophylactic postoperative measures to minimize surgical site infections in spine surgery: systematic review and evidence summary

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

Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

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