Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Abstract

<p class="MsoNormal"> <span lang="EN-US">Background:</span><span lang="EN-US"> </span><span lang="EN-US">Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that chal</span><span lang="EN-US">lenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compart</span><span lang="EN-US">ment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy.</span><span lang="EN-US"> </span><span lang="EN-US">Aim</span><span lang="EN-US">: </span><span lang="EN-US">To ascertain if prophylactic drainage of clean orthopaedic wound</span><span lang="EN-US">s</span><span lang="EN-US"> confer</span><span lang="EN-US"> </span><span lang="EN-US">any significant ad</span><span lang="EN-US">vantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods</span><span lang="EN-US">: </span><span lang="EN-US">A prospective analysis of</span><span lang="EN-US"> </span><span lang="EN-US">62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomization process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infection, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was ana</span><span lang="EN-US">lysed using SPSS statistics version 20 (IBM Corp.</span><span lang="EN-US">,</span><span lang="EN-US"> New York).</span><span lang="EN-US"> </span><span lang="EN-US">Results</span><span lang="EN-US">: </span><span lang="EN-US">There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteo</span><span lang="EN-US">synthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a sig</span><span lang="EN-US">nificantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39</span><span lang="EN-US"> </span><span lang="EN-US">+</span><span lang="EN-US"> </span><span lang="EN-US">0.56</span><span lang="EN-US"> </span><span lang="EN-US">secs versus 2.03</span><span lang="EN-US"> </span><span lang="EN-US">+</span><span lang="EN-US"> </span><span lang="EN-US">0.41</span><span lang="EN-US"> </span><span lang="EN-US">secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group.</span><span lang="EN-US"> </span><span lang="EN-US">Conclusion</sp...

Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

“…In patients with SSI, all infections were superficial and responded to culture sensitive antibiotic therapy and local wound care. These findings are consistent with results from a study of orthopaedic surgery patients of any type that reported a 12.8% rate of superficial wound infection with drain use and 3.2% without drain use [4]. Our findings support the evidence that drain use in orthopaedic wounds is associated with a higher risk of surgical site infection [4,18].…”

“…These findings are consistent with results from a study of orthopaedic surgery patients of any type that reported a 12.8% rate of superficial wound infection with drain use and 3.2% without drain use [4]. Our findings support the evidence that drain use in orthopaedic wounds is associated with a higher risk of surgical site infection [4,18]. However, prior literature is equivocal with several studies demonstrating no difference or even decreased rates of infection with drain use [10,19,20].…”

“…Prophylactic surgical wound drains are commonly used in resource poor settings, particularly following intramedullary nailing (IMN) of long bone diaphyseal fractures with readily available Surgical Implant Generation Network (SIGN) nails [1][2][3]. Drains are used in these settings due to the lack of advanced operative equipment such as electrocautery and minimal access techniques, and it continues to remain the standard of care in some resource limited settings [4]. Prophylactic surgical drainage following musculoskeletal injuries has been suggested to reduce hematoma formation and surgical site infection (SSI), to decrease wound swelling and the sequelae of compartment syndrome, and to enhance the local wound environment [5][6][7][8].…”

“…However, the indications for drain use in resource-poor settings are controversial. Recent evidence suggests that prophylactic drains do not confer any benefit and predispose clean wounds to infection [4,9]. Wound drainage following open reduction and internal fixation of femoral fractures has shown no significant difference in the rate of wound infection [6,[10][11][12].…”

“…Thus, prophylactic surgical drainage following clean IMN procedures occurs in the absence of evidence demonstrating improved patient outcomes and contributes to increased cost of care. Ikpeme et al reported that prophylactic wound drainage conferred no patient outcome advantages while contributing to increased patient costs in a Nigerian teaching hospital [4].…”