The Use of Postoperative Subcutaneous Closed Suction Drainage After Posterior Spinal Fusion in Adolescents with Idiopathic Scoliosis

Blank, John; Flynn, John M.; Bronson, William; Ellman, Peter I.; Pill, Stephan G.; Lou, Julia; Dormans, John P.; Drummond, Denis S.; Ecker, Malcolm L.

doi:10.1097/00024720-200312000-00004

Cited by 49 publications

(53 citation statements)

References 16 publications

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“…No additional studies were obtained after the reference review. Ultimately, four non-RCTs and four RCTs [ 10 – 15 , 18 , 19 ] were eligible for data extraction and meta-analysis, as indicated by the flowchart in Fig. 1 .…”

Section: Resultsmentioning

confidence: 99%

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Wound drains in posterior spinal surgery: a meta-analysis

Liu

2016

J Orthop Surg Res

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BackgroundThe use of drains following posterior spinal surgery is controversial. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in posterior spinal surgery.MethodsAll randomized and non-randomized controlled trials comparing the use of closed suction drainage with no drainage in posterior spinal surgery were sought in PubMed, Medicine, Embase, and other Internet databases. All of the literature was searched and assessed by two independent reviewers, according to the standards of Cochrane systematic reviews. Data on functional and radiological outcomes in the two groups were pooled, which were then analyzed with RevMan software, version 5.2.ResultsFour randomized controlled trials (RCTs) and four non-RCTs met the inclusion criteria. Meta-analysis revealed that no significant differences were found regarding wound infection (P = 0.83), hematoma (P = 0.48), neurological injury (P = 0.21), estimated blood loss (P = 0.59), or dry and moderate dressing drainage between the groups. The number of patients with saturated dressings was larger in the no drainage group (P = 0.002).ConclusionsThere is no obvious evidence to support the application of closed suction drains for posterior spinal surgery. Because of the limited quality of the evidence currently available, more high-quality RCTs with better experimental designs and larger patient samples should be performed.

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Section: Resultsmentioning

confidence: 99%

“…The use of closed suction drainage in posterior spinal surgery remains controversial [ 10 – 15 ]. Therefore, we conducted a meta-analysis, pooling the data from randomized controlled trials (RCTs) and non-RCTs to provide an evidence-based judgment regarding the use of closed suction drainage in posterior spinal surgery.…”

Section: Introductionmentioning

confidence: 99%

Wound drains in posterior spinal surgery: a meta-analysis

Liu

2016

J Orthop Surg Res

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“…A recent practice survey found that drains are routinely placed out of habit with a wide range of patterns [56], despite the fact that a randomized controlled trial performed by Blank et al [57], showed that subcutaneous drains conferred an advantage regarding wound care.…”

Section: Supporting Empirical Evidencementioning

confidence: 99%

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

et al. 2014

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Purpose The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40°and 90°Cobb angle. Methods From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with C70 % agreement. Data were analyzed qualitatively and quantitatively.Results Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of \80 % for 40°-70°curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre-and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning. operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

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“…11–14 Conversely, some studies have found an association between drains and increased postoperative blood transfusions and wound infection after spinal fusion. 15–17 There is also evidence that drains may be associated with postoperative fevers after lumbar spine surgery. 13,18 …”

Section: Introductionmentioning

confidence: 99%

Factors Predictive of Increased Surgical Drain Output After Anterior Cervical Discectomy and Fusion

Basques

Bohl

Golinvaux

et al. 2014

Spine

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Study Design Retrospective cohort study. Objective To identify factors that are independently associated with increased surgical drain output in patients who have undergone ACDF. Summary of Background Data Surgical drains are typically placed following ACDF to reduce the risk of complications associated with neck hematoma. The orthopaedic literature has repeatedly challenged the use of surgical drains following many procedures, and there are currently no guidelines for determining which patients are most likely to benefit from drain placement after ACDF. Methods Consecutive patients who underwent elective ACDF with surgical drain placement at a single academic institution between January 2011 and February 2013 were identified using billing records. Patient information was abstracted from the medical record. Patients were categorized based on normal or increased total drain output, with increased drain output defined as total drain output ≥ 50th percentile (30mL). A multivariate logistic regression was used to determine which factors were independently associated with increased drain output. Results A total of 151 ACDF patients met inclusion criteria. Total drain output ranged from 0 mL to 265 mL. The average drain output for this cohort was 42.3 ± 45.5 mL (mean ± standard deviation). Among all patients in the study, 80 patients had increased drain output (drain output ≥ 50th percentile or 30 mL). Multivariate analysis identified three independent predictors of increased drain output: age ≥ 50 years (Odds Ratio [OR] = 3.9), number of levels (2 levels, OR = 2.7; 3–4 levels, OR = 17.0), and history of smoking (OR = 2.8). One patient developed a postoperative neck hematoma while a drain was in place. Conclusion Patients with the above-identified factors associated with increased drain output may benefit most from surgical drain placement after ACDF. Nonetheless, neck hematoma is still possible even with drain use.

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The Use of Postoperative Subcutaneous Closed Suction Drainage After Posterior Spinal Fusion in Adolescents with Idiopathic Scoliosis

Cited by 49 publications

References 16 publications

Wound drains in posterior spinal surgery: a meta-analysis

Wound drains in posterior spinal surgery: a meta-analysis

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

Factors Predictive of Increased Surgical Drain Output After Anterior Cervical Discectomy and Fusion

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