Routine drainage after thyroid surgery—A meta‐analysis

Abstract

Thyroidectomy is a common surgical procedure. The results of some clinical trials suggest that routine drainage does not offer advantages, but the evidence is not strong either in favor of or against this intervention. The effect of routine drainage compared to no drainage in patients subject to thyroidectomy was measured using a meta-analysis. After an extensive literature review, suitable randomized clinical trials were selected for analysis. Outcome measures included the comparative incidence of neck hematoma or seroma and length of hospital stay. Eleven randomized clinical trials were included. There were no statistically significant differences in the incidence of neck hematoma/seroma (OR 1.03, 95% CI 0.59-1.81) between the groups. The mean length of hospital stay was 1.53 days longer for the drainage group (95% CI 1.39-1.68). There was no difference found between routine drainage and no drainage with regard to the frequency of postoperative hematoma/seroma in patients following thyroidectomy. In addition, the mean length of hospital stay was longer in the routine drainage group.

Safety of thyroidectomy and cervical neck dissection without drains

“…[2][3][4][5][6] Furthermore, no difference in perioperative complications (seroma, hematoma, hemorrhage) was found among the 3 types of surgical procedures (hemithyroidectomy, total thyroidectomy, total thyroidectomy with CND) in either group. There was no major bleeding in either group.…”

“…Many authors have demonstrated that drainage after uncomplicated thyroid surgery, including total thyroidectomy, lobectomy and subtotal thyroidectomy, does not decrease the rate of complications related to postoperative bleeding. [2][3][4][5][6][7] Most hematomas are clinically apparent within 2-4 hours after surgery, and some occur 2-48 hours postoperatively. The diagnosis of wound hematoma is made by observing the neck and noticing a progressive collection under the skin or airway symptoms.…”

“…Others have suggested selective or no use of drains after thyroidectomy, since the use of drains does not prevent the development of postoperative hematoma and increases the length of postoperative stay in hospital. [2][3][4][5][6][7] Other authors have concluded that thyroidectomy without drains is safe, even when combined with central neck dissection (CND). 8 The present paper aimed to evaluate the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND (central and/or lateral).…”

The Impact of Pressure Dressing on Post-Thyroidectomy Hypocalcemia: Prospective Randomized Controlled Clinical Study

“…For minimizing the risk for hematoma and seroma, the formation of dead space should be reduced, in addition to effective bleeding control. In the literature, in the studies conducted on the necessity of drain usage, drained and non-drained patients were compared in terms of postoperative hematoma, seroma, and the amount of the liquid accumulation in the thyroidectomy bed, and similar results were reported for both groups (1,2). Nevertheless, many surgeons still use drain after thyroidectomy (1)(2)(3).…”

“…In the literature, in the studies conducted on the necessity of drain usage, drained and non-drained patients were compared in terms of postoperative hematoma, seroma, and the amount of the liquid accumulation in the thyroidectomy bed, and similar results were reported for both groups (1,2). Nevertheless, many surgeons still use drain after thyroidectomy (1)(2)(3). Another way of reducing post-thyroidectomy dead space volume is to perform pressure dressing with drainage (3).…”