The current state of the evidence for the use of drains in spinal surgery: systematic review

Patel, Sonam; Griffiths-Jones, William; Jones, Conor S; Samartzis, D; Clarke, Andrew; Khan, Shahid Ali; Stokes, Oliver M.

doi:10.1007/s00586-017-4983-0

Cited by 41 publications

(35 citation statements)

References 27 publications

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“…24 However, Patel et al showed in their systematic review that drains do not reduce the prevalence of pSEH. 25 Ahn et al examined the diameter of the drains. They found larger drains did not prevent pSEH 26 compared with smaller drains.…”

Section: Prevalencementioning

confidence: 99%

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Hohenberger

Zeman²,

Höhne

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Postoperative spinal epidural hematoma (pSEH) with symptomatic compression of nervous structures after spinal decompression surgery is a rare complication. Delayed evacuation may result in severe neurologic impairment. We present a large single-center analysis of the prevalence, potential risk factors, and functional recovery after pSEH. Methods A retrospective review of our institutional database of spinal decompression surgery over 15 years yielded 6,024 consecutive patients. A total of 42 patients who had undergone surgical revision due to postoperative neurologic deterioration or intractable radiating pain and radiographically confirmed pSEH were allocated to the pSEH group. A matched 3:1 control group was formed (126 patients with the same surgical procedure, same year, same sex, and similar age). Charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, history of medical treatment, medication, comorbidities, radiographic extension, surgical strategy, and pre- and postoperative neurologic performance. Median follow-up was 3 months. Risk factors for pSEH, complete recovery, and recovery of neurologic symptoms were analyzed with univariable and multivariable logistic regression models. Results The prevalence of pSEH in this population was 0.69% (n = 42) with these locations: 7 of 1,284 (0.54%) cervical, 1 of 774 (0.12%) thoracic, and 34 of 3,966 (0.85%) lumbar. Use of anticoagulants (p = 0.003), pathologic coagulation values in the preoperative blood test (p = 0.034), and cigarette smoking (p = 0.003) were identified as independent risk factors of pSEH. Surgery in more than one level showed a trend toward an increased risk of pSEH. Pain as the only symptom (p = 0.0001) was a significant predictor of complete recovery. Patients symptomatic with paraplegia (p = 0.026) had a significantly higher risk of a poor neurologic outcome without full recovery of neurologic symptoms. Conclusion The prevalence of pSEH was lower than previously reported incidences. Use of anticoagulants, pathologic coagulation values, and cigarette smoking were identified as independent risk factors of pSEH. Functional outcome was related to the duration between hematoma evacuation and the clinical presentation of symptomatic pSEH.

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Section: Prevalencementioning

confidence: 99%

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Hohenberger

Zeman²,

Höhne

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…Although it is agreed that the use of drains should decrease the incidence of postoperative hematoma formation and hence the incidence of infection, systematic reviews have shown a paucity of level I or II evidence suggesting benefits from the employment of drains in orthopedic 7 and in spinal surgery. 8 A prospective randomized study compared the results following single-level laminectomy with and without drain reaching the conclusion that the usage of drain did not affect the rate of complication 9 . The same conclusion was reported by an additional prospective randomized study performed on use of drain following extensive lumbar spine surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of evidence regarding the effectiveness of closed-suction drainage in spinal surgery. 8 Drainage is used to reduce the incidence of complications especially neurologic impairment as a result of hematoma formation or accumulation of exudative fluid and hence wound healing complication. 2 An additional benefit of drainage use in spine surgery may be the prevention of postoperative fibrosis and hence adhesions that may complicate decompression surgery and usually cause treatment failure.…”

Section: Introductionmentioning

confidence: 99%

“…With regard to lumbar spine surgery, many surgeons stopped using drains following single-level decompression procedures; however, there is still controversy regarding using drains after extensive decompression and fusion surgery. 8 One parameter that is not studied yet is the impact of wound drainage on postoperative pain and duration of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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One- or Two-Level Transforaminal Lumbar Interbody Fusion without Closed-Suction Wound Drainage

Rizk

Ottenbacher

2019

Egyptian Spine Journal

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Background Data: Although many surgeons stopped using closed-suction drainage following simple spine decompression surgery, there is still debate regarding the necessity of wound drainage in more extensive lumbar spine surgical procedures. Purpose: To estimate the advantages and disadvantages of performing one-or two-level transforaminal lumbar interbody fusion (TLIF) without closed-suction drainage. Study Design: Retrospective clinical cohort study. Patients and Methods: The Fast-Track technique was performed in 36 consecutive TLIF surgeries between January and September 2016 without using wound drainage. Twenty-eight patients were females and 8 were males. Thirty patients had single-level TLIF and 6 double-level TLIF. The results of these patient series were retrospectively analyzed. The variables that were reviewed included blood transfusion, postoperative temperature, postoperative pain and the use of opiates during hospital stay, duration of surgery, duration of hospital stay, and incidence of postoperative complications such as neurological deficit, hematoma, postoperative wound infection, and revision surgery. Results: There was no postoperative allogenic blood transfusion; the patients did not develop postoperative neurological deficit; there were no cases of surgical revision as a result of significant postoperative hematoma or infection. There were two cases (5.5%) of revision surgery due to persistent CSF leakage from the wound. Four patients (11.1%) developed serous discharge from the wound, which was treated conservatively with frequent dressing and antibiotics. Four patients (11.1%) developed transient postoperative fever. The mean pain score in the first 2 days after surgery assessed by the Visual Analogue Score (VAS) was 6.1 points, and additional opiate in the first 2 postoperative days was mandatory in 30 patients (83.3%). Conclusion:Performing one-or two-level lumbar decompression and fusion without closed-suction wound drainage did not increase the rate postoperative infection or hematoma formation. Additionally, none of our patients required postoperative blood transfusion. (2019ESJ168)

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“…Despite being widely used, the effectiveness of drains in decreasing post-operative hematoma formation and infection has been recently been called into question (14)(15)(16)(17)(18)(19). A few studies have shown no difference in clinical outcomes and complications profile with and without drain use (10,(14)(15)(16)(17)(20)(21)(22)(23)(24)(25)(26). Others have suggested that drain placement negatively impacts outcomes leading to significantly greater use of allogenic blood transfusions, post-hemorrhagic anemia (26) as well as prolonged length of hospital stay (LOS) (19).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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The current state of the evidence for the use of drains in spinal surgery: systematic review

Cited by 41 publications

References 27 publications

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

One- or Two-Level Transforaminal Lumbar Interbody Fusion without Closed-Suction Wound Drainage

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

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