Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial

Губин, А.В.; Прудникова, О. Г.; Subramanyam, Koushik Narayan; Burtsev, A. V.; Khomchenkov, Maxim Viktorovich; Mundargi, Abhishek Vasant

doi:10.1007/s00586-018-5791-x

Cited by 27 publications

(25 citation statements)

References 20 publications

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“…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: 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%

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

et al. 2020

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“…Eighty patients were allocated to a suction drainage group and 75 to a control group. Despite one case of superficial wound inflammation in each group, there were no SSIs [27]. [28].…”

Section: Impact On Wound Healingmentioning

confidence: 88%

“…Gubin et al demonstrated a significantly higher number of patients requiring blood transfusion after posterior spinal surgery involving more than one motion segment in the cohort with drains than those without (10% vs. 0.1%) [27].…”

Section: Impact On Blood Loss and Transfusion Requirementsmentioning

confidence: 99%

“…Regarding blood loss depending on the use of drains, type of application, localisation and duration, we refer to the preceding chapters. With a focus on the need for transfusion requirements, nine studies dealt with this question in more detail and came to diverging results [16,18,24,27,[32][33][34][35][36].…”

Section: Impact On Blood Loss and Transfusion Requirementsmentioning

confidence: 99%

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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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The Michel Benoist and Robert Mulholland yearly European spine journal review: a survey of the “surgical and research” articles in European spine journal, 2019

Mulholland

2020

Eur Spine J

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Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial

Cited by 27 publications

References 20 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

The Michel Benoist and Robert Mulholland yearly European spine journal review: a survey of the “surgical and research” articles in European spine journal, 2019

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