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Mallory N, Gibbs D, Belmonte A, Mallory TH, Santiago-Torres J. Utility of prophylactic closed suction drainage in open reduction and internal fixation for tibial plateau fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:271-277. [PMID: 37452136 DOI: 10.1007/s00590-023-03581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The usefulness of closed suction drains (CSD) after open reduction and internal fixation (ORIF) of tibial plateau fractures is a contested topic. The purpose of this study was to examine the impact of CSD in postoperative outcomes after tibial plateau fracture. METHODS Data were retrospectively collected from patients who underwent primary repair of closed tibial plateau fractures via an anterolateral approach between June 2021 to May 2022 at a single academic center. Fifty-six patients were included and 28 received CSDs at time of surgery. P values less than 0.05 were considered significant. RESULTS Fifty-six patients were included. There was no significant difference in demographics, pre- and post-op hemoglobin, estimated blood loss during surgery, length of stay, postoperative MMEs and pain at 3 month follow-up, deep vein thrombosis (DVT), compartment syndrome, flexion contracture, use of incisional vac, infection rate, wound drainage, hematoma, neurologic pain, dehiscence, additional surgery, or range of motion at 3 months follow-up. We noted a significant difference in Defense and Veterans Pain Rating Scale (DVPRS) on POD1, demonstrating greater pain in those in the CSD group. CONCLUSION Our findings suggest that the use of CSD in ORIF of tibial plateau fractures may not be of significant prophylactic benefit. CSDs in ORIF patients were associated with increased early postoperative pain and had no identifiable benefits. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anthony Belmonte
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA
| | - Thomas H Mallory
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juan Santiago-Torres
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, 241 W 11th Ave, Suite 6065L, OH, 43201, Columbus, USA.
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Shimozaki K, Nakase J, Yoshimizu R, Kanayama T, Yanatori Y, Sengoku T, Tsuchiya H. Non-use of intra-articular drain after anterior cruciate ligament reconstruction does not affect postoperative knee pain and muscle strength on early period. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 32:7-11. [PMID: 37223278 PMCID: PMC10201551 DOI: 10.1016/j.asmart.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/06/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction This study aimed to determine the effect of using an intra-articular drain after anterior cruciate ligament (ACL) reconstruction on early postoperative pain, range of motion (ROM), muscle strength, and complications. Materials and methods Between 2017 and 2020, of the 200 consecutive patients who underwent anatomical single-bundle ACL reconstruction, 128 patients underwent primary ACL reconstruction with hamstring tendons and were evaluated for postoperative pain and muscle strength at 3 months postoperatively. Sixty-eight patients who received intra-articular drain before April 2019 were classified as group D and 60 patients without an intra-articular drain after ACL reconstruction after May 2019 were classified as group N. Patient background, operative time, postoperative pain, number of additional analgesics used, presence of intra-articular hematoma, ROM at 2, 4, and 12 weeks postoperatively, extensor and flexor muscle strength at 12 weeks postoperatively, and perioperative complications were compared between the two groups. Results The postoperative pain at 4 h after surgery was significantly greater in group D than in group N although no significant difference was found in the pain felt in the immediate postoperative period and at 1 day and 2 days postoperatively and in the number of additional analgesics used. No significant difference in the postoperative ROM and muscle strength was noted between the two groups. Six patients with intra-articular hematomas in group D and four patients in group N needed puncture by 2 weeks postoperatively, and no significant difference was found between the two groups. Conclusion Postoperative pain was greater at 4 h postoperatively in group D. Furthermore, the intra-articular drain did not affect muscle strength, ROM, and complications on the early postoperative period. The usefulness of intra-articular drain after ACL reconstruction was considered low. Level of Evidence Level IV.
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Affiliation(s)
| | - Junsuke Nakase
- Corresponding author. 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.
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Amanullah A, Patel A, Samdani AF, Pahys JM, Toll BJ, Ackshota N, Kim AJ, Hwang SW. Do drains help reduce the risk of complications after thoracoplasties in posterior spinal fusions for adolescent idiopathic scoliosis? Childs Nerv Syst 2022; 38:557-564. [PMID: 34860260 DOI: 10.1007/s00381-021-05421-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In adolescent idiopathic scoliosis (AIS), the rib prominence is a major cosmetic concern which can be improved using thoracoplasties. We sought to determine if the use of deep drains helps minimize the development of pleural effusions after thoracoplasties. METHODS Retrospective study of 45 patients with AIS undergoing posterior spinal fusion (PSF) and thoracoplasties. RESULTS Thirty six out of 45 patients (80.0%) required placement of a deep surgical drain, and 16 out of 45 (35.6%) developed pleural effusions after PSF with concomitant thoracoplasty. Of the 16 patients who developed pleural effusion, 12 of 36 (33.3%) required a placement of a deep drain (p > 0.05). Of the total 45 patients in this cohort, 3 patients (6.7%) required chest tubes, and 4 patients (8.9%) developed surgical site infections (SSIs). We found that deep drains were associated with a lower incidence of SSI (2.8% vs 33.3%; p = 0.021). Patients who had a pleural effusion had longer ICU stays (p = 0.037) and longer requirements of nasal oxygen (p = 0.025). DISCUSSION The presence of a pleural effusion in patients with AIS undergoing PSF with thoracoplasty was associated with longer oxygen requirements and length of hospital ICU admission. Thirty six percent of patients with thoracoplasties developed pleural effusions, but deep subfascial drains did not significantly decrease the incidence of pleural effusions.
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Affiliation(s)
- Amir Amanullah
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Akul Patel
- Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Brandon J Toll
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Nissim Ackshota
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Andrew Jeongyoon Kim
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
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Zhu C, Zhang J, Li J, Zhao K, Meng H, Zhu Y, Zhang Y. Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study. BMC Musculoskelet Disord 2021; 22:258. [PMID: 33685429 PMCID: PMC7941723 DOI: 10.1186/s12891-021-04132-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. Methods From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. Results The incidence of SSI was 6.0 % (22/364): 2.4 % (9/364) for superficial SSIs and 3.6 % (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8 %,7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. Conclusions The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization. Trial registration NO 2014-015-1, October /15/2014, prospectively registered. We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.
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Affiliation(s)
- Chao Zhu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China.,Department of Orthopedics, the Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China
| | - Junyong Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Hebei Province, 050051, Shijiazhuang, PR China. .,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province , Shijiazhuang Province, Shijiazhuang, China.
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Zhang JZ, Zhao K, Li JY, Meng HY, Zhu YB, Zhang YZ. Prophylactic Closed Suction Drainage Is Irrelevant to Accelerated Rehabilitation after Open Reduction and Internal Fixation for Closed Distal Femur Fractures. Orthop Surg 2020; 12:1768-1775. [PMID: 33047488 PMCID: PMC7767690 DOI: 10.1111/os.12812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To investigate whether closed suction drainage (CSD) is related to accelerated rehabilitation of patients after open reduction and internal fixation (ORIF) for closed distal femur fractures. Methods This study was a prospective, randomized controlled clinical trial. Between October 2018 and June 2020, 160 closed distal femur fracture patients who were prepared for ORIF were prospectively randomized into two groups: a CSD group with the mean age of 57.91 ± 14.38 years (32 [40%] men and 48 [60%] women) and a non‐CSD group with the mean age of 59.73 ± 17.55 years (27 [34%] men and 54 [66%] women). Wound visual analogue scale (VAS) pain scores, peri‐wound skin temperature, hematocrit (Hct), hemoglobin (Hb) concentrations, hidden blood loss (HBL), dressing change, period of wound oozing, postoperative blood transfusion, and length of postoperative hospital stay were recorded. Postoperative wound complications, namely wound infections, wound haematoma, wound dehiscence, erythema of wound, and lower limb deep vein thrombosis (DVT) were collected. All the patients were administrated by a single surgical team and followed up for 1 month after the ORIF. Results The patients without CSD were identified with lower peri‐wound skin temperature and wound VAS pain scores during the first three postoperative days (36.69 ± 0.33 vs 36.86 ± 0.38 °C, P = 0.002; 1.88 ± 0.82 vs 3.15 ± 1.15, P = 0.000). However, both the peri‐wound skin temperature and wound VAS pain scores did not differ significantly between the two groups on the fifth postoperative day. In addition, patients with CSD had a longer length of postoperative hospitalization time (11.45 ± 5.95 vs 9.78 ± 4.64 days, P = 0.049). There was no statistically significant difference between CSD and non‐CSD groups within 1 month after the ORIF regarding blood loss, period of wound oozing, and postoperative complications, such as incidence of wound infection, haematoma, erythema, dehiscence, and lower limb DVT. Conclusion Prophylactic CSD after primary ORIF for closed distal femur fractures not only had no significant advantage to minimize blood loss and wound complications, but increased local inflammation and postoperative hospital stay, and thus we suggest that prophylactic CSD after primary ORIF for closed distal femur fractures is not recommended for optimized clinical pathways and accelerated recovery.
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Affiliation(s)
- Jun-Zhe Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Kuo Zhao
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Jun-Yong Li
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China.,Department of Orthopaedic Surgery, The Second Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Hong-Yu Meng
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Yan-Bin Zhu
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Ying-Ze Zhang
- The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
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Guo H, Wang B, Ji Z, Gao X, Zhang Y, Yuan L, Hao D. Closed drainage versus non-drainage for single-level lumbar discectomy: a prospective randomized controlled study. BMC Musculoskelet Disord 2020; 21:484. [PMID: 32698855 PMCID: PMC7376945 DOI: 10.1186/s12891-020-03504-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022] Open
Abstract
Background Postoperative epidural haematoma and wound infection can cause devastating neurological damage in spinal surgery. Closed drainage is a common method to prevent epidural haematoma, infection and related neurological impairment after lumbar decompression; however, it is not clear whether drainage can reduce postoperative complications and improve clinical efficacy. This randomized study aims to explore the role of closed drainage in reducing postoperative complications and improving the clinical efficacy of single-level lumbar discectomy. Methods A total of 420 patients with single-level lumbar disc herniation were finally included in this study (169 females and 251 males, age 50.0 ± 6.4 years). A total of 214 patients were randomly assigned to the closed drainage group, and 206 patients were assigned to the non-drainage group. The incidence of postoperative fever, symptomatic epidural haematoma, wound infection and the need for revision surgery were compared between the two groups by the chi-square test or Fisher’s exact test. The visual analogue scale (VAS) and oswestry disability index (ODI) were used to evaluate the improvement of pain relief and the recovery of lumbar function. The VAS and ODI scores were compared between the two groups using t tests. Results The complications of the two groups were compared and analysed. There was only a statistically significant difference in the postoperative fever rate (p = 0.022), as the non-drainage group had a higher fever rate, but there were no significant differences in the rates of symptomatic epidural haematoma, wound infection or revision operation (p > 0.05). After concrete analysis, for the rate of fever less than 38.5 degrees, there was a statistically significant difference (p = 0.027), but there was no significant difference when the fever was greater than 38.5 degrees (p > 0.05). When comparing the VAS scores of the operation area on the first day after the operation, the pain relief in the closed drainage group was significantly better than that in the non-drainage group, with scores of 5.1 ± 0.8 and 6.0 ± 0.7, respectively (p < 0.001). However, there was no significant difference between the two groups in the other VAS scores of operation areas, the VAS scores of the lower extremity, or the ODI scores (p > 0.05). Conclusions For single-level lumbar discectomy, closed drainage is beneficial for reducing postoperative low-grade fever and relieving pain in the operation area in the very early postoperative stage. However, drainage does not have a significant impact on reducing the incidence of postoperative complications or improving clinical efficacy. Trial registration Current Controlled Trials ChiCTR1800016005, May/06/2018, retrospectively registered.
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Affiliation(s)
- Hua Guo
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China
| | - Biao Wang
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China
| | - Zhaohua Ji
- Department of epidemiology, Shaanxi Provincial Key Laboratory of Free Radical Biology and Medicine, The Ministry of Education Key Laboratory of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xi Gao
- Department of Intensive Care Unit, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China
| | - Yuting Zhang
- Department of Computed Tomography, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China
| | - Li Yuan
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, Shaanxi, China.
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Impact of closed suction drainage after surgical fixation of acetabular fractures. Arch Orthop Trauma Surg 2019; 139:907-912. [PMID: 30687873 DOI: 10.1007/s00402-019-03110-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of the present study was to evaluate the prevalence of closed suction drainage after a Kocher-Langenbeck (K-L) approach for surgical fixation of acetabular fractures and to determine the impact of closed suction drainage on patient outcomes. METHODS This retrospective study reports on 171 consecutive patients that presented to a single level I trauma center for surgical fixation of an acetabular fracture. Medical records were reviewed to evaluate the use of closed suction drains. The primary outcomes measures were rate of packed red blood cell (PRBC) transfusion and length of hospital stay (LOS). Secondary outcome measures were 30-day post-operative wound complication and 1-year deep infection rates. RESULTS Of the 171 patients included in this study, 140 (82%) patients were treated with drains. There was a significant association between the use of closed suction drainage and post-operative blood transfusion rate (p = 0.002). Thirty-five patients (25%) treated with drains required a post-operative blood transfusion compared to 0% in the no drain cohort. Regarding the total number of drains used, for every additional closed suction drain that was placed beyond a single drain, the odds of receiving a blood transfusion doubled (p = 0.002). Use of closed suction drainage was associated with a significantly longer LOS (p = 0.015), and no difference in wound complication or deep infection rates. CONCLUSION The use of closed suction drains for treatment of acetabular fractures using a K-L approach is associated with increased rates of blood transfusion and increased length of hospital stay, with no impact on surgical site infection rates. The results of this study suggest against routine drain usage in acetabular surgery.
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A Drain-free Technique for Female-to-Male Gender Affirmation Chest Surgery Decreases Morbidity. Ann Plast Surg 2019; 83:15-21. [DOI: 10.1097/sap.0000000000001810] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adogwa O, Khalid SI, Elsamadicy AA, Voung VD, Lilly DT, Desai SA, Sergesketter AR, Cheng J, Karikari IO. The use of subfascial drains after multi-level anterior cervical discectomy and fusion: does the data support its use? JOURNAL OF SPINE SURGERY 2018; 4:227-232. [PMID: 30069511 DOI: 10.21037/jss.2018.05.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Subfascial drains are routinely used after multi-level anterior cervical discectomy and fusion (ACDF) procedures despite little evidence to support their use. Proponents of drain use argue that drain placement reduces the incidence of post-operative hematomas and surgical site infections (SSI). The aim of this study is to determine whether the use of subfascial drains after multi-level ACDFs are associated with a decreased incidence of hematomas and SSIs. Methods This is a retrospective study of 321 consecutive adult patients (18 years and older) with degenerative cervical stenosis that undergoing an index multi-level ACDF procedure. Only patients undergoing multilevel ACDF were included in the study. Patients were separated into one of two groups depending whether a subfascial drain was placed during surgery. The decision to place a drain was based on surgeon preference. Baseline characteristics, operative details, as well as rates of hematoma formation and SSIs were gathered by direct medical record review. Results Of the 321 patients enrolled in the study, 58 (18%) patients had subfascial drains placed at the time of surgery. Baseline demographics and co-morbidities were similar between both cohorts; however, on average, patients in the "Drain Use" cohort were older when compared to those in the "No Drain" cohort (64 vs. 56 years old, P<0.0001). There was no observed difference between both groups in the incidence of post-operative hematoma formation (P=0.99) or SSI (P=0.99). Five percent of patients in the "Drain Use" cohort required a post-operative allogenic blood transfusion compared to less than 1% (0.4%) in the comparison cohort. The duration of hospital stay was almost 2-fold longer in the in the "Drain use" cohort compared to the comparison cohort ("Drain Use": 2.82 days vs. "No Drain": 1.58 days, P<0.0001). Conclusions The use of subfascial drains after multi-level ACDF procedures were not associated with a decreased incidence of hematoma formation or SSIs. In fact, patients in which a subfascial drain was used were 14 times more likely to require a post-operative blood transfusion and with an almost 2-fold increase in the duration of in-hospital stay.
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Affiliation(s)
- Owoicho Adogwa
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Syed I Khalid
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Victoria D Voung
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel T Lilly
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Shyam A Desai
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Liang J, Hu J, Chen C, Yin H, Dong F. Risk factors for predicting increased surgical drain output in patients after anterior cervical corpectomy and fusion. J Orthop Surg Res 2017; 12:196. [PMID: 29282105 PMCID: PMC5745894 DOI: 10.1186/s13018-017-0698-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/09/2017] [Indexed: 11/12/2022] Open
Abstract
Background Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial. Methods A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis. Results The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P > 0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P = 0.000). The mean age was 60.67 ± 8.18 years versus 54.41 ± 10.05 years (P = 0.001). Number of discs involved was 2.42 ± 0.50 versus 2.02 ± 0.65 (P = 0.001). Operation time was 112.22 ± 16.49 min versus 105.21 ± 17.89 min (P = 0.031). Intraoperative blood loss was 109.86 ± 62.02 mL versus 87.83 ± 56.40 mL (P = 0.036). Logistic regression analysis showed that age (OR, 1.075; p = 0.003), history of smoking (OR, 2.792; p = 0.021), OPLL in surgical level (OR, 2.107; p = 0.001), and number of discs involved (OR, 2.764; p = 0.003) maintained its significance in predicting likelihood of increased surgical drain output. Conclusions The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.
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Affiliation(s)
- Jinqian Liang
- Department of Orthorpaedic Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - Jianhua Hu
- Department of Orthorpaedic Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng district, Beijing, 100730, People's Republic of China.
| | - Chong Chen
- Department of Orthorpaedic Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - Hao Yin
- Department of Spine Union, Hunan Provincial People's Hospital, No.61 Jiefangxi Road, Changsha, Hunan, 410005, People's Republic of China
| | - Fangliang Dong
- Department of Spine Union, Puyang Anyang Area Hospital, No.260 Dengta Road, Anyang, Henan, 455000, People's Republic of China
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Prunières G, Hidalgo Diaz JJ, Vernet P, Salazar Botero S, Facca S, Liverneaux PA. Is there a relevance of suction drainage in non-septic wrist surgery? Orthop Traumatol Surg Res 2017; 103:453-455. [PMID: 28163242 DOI: 10.1016/j.otsr.2017.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/15/2016] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION No rational argument leads to conclude to the benefit or the innocuousness of drainage in non-septic wrist surgery. HYPOTHESIS The goal of this study was to validate the hypothesis that for those indications drainage is unnecessary. MATERIAL AND METHOD We reviewed 1001 consecutive cases, concerning 885 patients, 58 years old in average. RESULTS Out of 1001 procedures, 9 patients were operated on both sides, 145 were operated twice of which 130 for the implantation and then the removal of surgical material. None were reoperated for hematomas. Three patients were initially treated for an osteosynthesis using an anterior plate of distal radius and secondarily reoperated due to sepsis, one of them twice. The material was removed from two patients. The average time of tourniquet for those 3 osteosynthesis was significantly superior (84.33min) to the average time for the 595 other anterior distal radius plates (45.35min). CONCLUSION The results of our study show that suction drainage in non-septic wrist surgery is unnecessary. LEVEL OF EVIDENCE III descriptive retrospective study.
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Affiliation(s)
- G Prunières
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - J J Hidalgo Diaz
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - P Vernet
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - S Salazar Botero
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - S Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France
| | - P A Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67403 Illkirch-Graffenstaden, France.
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The Use of Closed Suction Drainage in Lumbar Spinal Surgery: Is It Really Necessary? World Neurosurg 2016; 90:109-115. [DOI: 10.1016/j.wneu.2016.02.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
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Waly F, Alzahrani MM, Abduljabbar FH, Landry T, Ouellet J, Moran K, Dettori JR. The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: A Systematic Review. Global Spine J 2015; 5:479-85. [PMID: 26682098 PMCID: PMC4671891 DOI: 10.1055/s-0035-1566288] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Study Design Systematic review. Objective Determine whether closed suction wound drains decrease the incidence of postoperative complications compared with no drain use in patients undergoing spine surgery for lumbar degenerative conditions. Methods Electronic databases and reference lists of key articles were searched up through January 22, 2015, to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection, and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group. Results Five heterogeneous studies, three randomized controlled trials, and two cohort studies form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with compared with patients without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered low or insufficient. Conclusions Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on closed suction wound drains in lumbar spine surgery until a higher level of evidence becomes available to support its use.
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Affiliation(s)
- Feras Waly
- McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada,Department of Orthopedic Surgery, University of Tabuk, Tabuk, Saudi Arabia,Address for correspondence Feras Waly, MD Montreal General Hospital, McGill University Health Centre1650 Cedar Avenue, T8-200, Montreal, QC H3G 1A4Canada
| | - Mohammad M. Alzahrani
- McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada,Department of Orthopedic Surgery, University of Dammam, Al-Dammam, Saudi Arabia
| | - Fahad H. Abduljabbar
- McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada,Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tara Landry
- McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada
| | - Jean Ouellet
- McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada
| | - Kathryn Moran
- Spectrum Research, Inc., Tacoma, Washington, United States
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Mears SC, Kates SL. A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2. Geriatr Orthop Surg Rehabil 2015; 6:58-120. [PMID: 26246957 DOI: 10.1177/2151458515572697] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.
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Abstract
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 after ACDF to reduce the risk of complications associated with neck hematoma. The orthopedic literature has repeatedly challenged the use of surgical drains after 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 on the basis of normal or increased total drain output, with increased drain output defined as total drain output 50th percentile (30 mL) or more. A multivariate logistic regression was used to determine which factors were independently associated with increased drain output. RESULTS A total of 151 patients with ACDF met inclusion criteria. Total drain output was in the range 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 3 independent predictors of increased drain output: age 50 years or more (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 factors associated with increased drain output identified in the earlier text may benefit most from surgical drain placement after ACDF. Nonetheless, neck hematoma is still possible even with drain use. LEVEL OF EVIDENCE 3.
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Negative pressure therapy on primarily closed wounds improves wound healing parameters at 3 days in a porcine model. J Orthop Trauma 2011; 25:756-61. [PMID: 22089760 DOI: 10.1097/bot.0b013e318211363a] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We investigated the role of negative pressure therapy (NPT) in postoperative primary wound treatment and closure. To date, extensive evidence exists demonstrating the benefit of negative pressure dressings in the treatment of open wounds; our experiment tested the hypothesis that negative pressure dressings improve healing of closed (sutured) wounds. METHODS A porcine model was used to collect data on the characteristics of closed wounds after 3 days of treatment with NPTs as compared with control dressings. RESULTS In six pigs with a total of 56 wounds, load to failure (N/mm) in controls was 0.348 (standard deviation [SD] 0.109) versus NPT at 0.470 (SD, 0.194) with a P value of 0.001; energy to failure (mJ/mm) in controls was 0.85 (SD, 0.378) versus NPT at 1.128 (SD, 0.638) with a P value of 0.035. Blinded grading of clinical wound appearance and cross-sectional hematoma size were also improved at 72 hours. CONCLUSIONS NPT dressings applied to surgically closed wounds enhance the healing characteristics of porcine wounds at 3 days. CLINICAL RELEVANCE We have observed that primarily closed surgical wounds may benefit from treatment with NPT. The benefit of using NPTs may be most pronounced in situations in which wounds are closed under tension, involve considerable soft tissue trauma, or may be at risk of subdermal hematoma formation.
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Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clin Orthop Relat Res 2011; 469:2621-30. [PMID: 21161736 PMCID: PMC3148392 DOI: 10.1007/s11999-010-1737-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/29/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear. QUESTIONS/PURPOSE We determined the incidence and quantified modifiable and nonmodifiable risk factors for SSIs in patients with orthopaedic trauma undergoing surgery. PATIENTS AND METHODS We retrospectively indentified, from our prospective trauma database and billing records, 1611 patients who underwent 1783 trauma-related procedures between 2006 and 2008. Medical records were reviewed and demographics, surgery-specific data, and whether the patients had an SSI were recorded. We determined which if any variables predicted SSI. RESULTS Six factors independently predicted SSI: (1) the use of a drain, OR 2.3, 95% CI (1.3-3.8); (2) number of operations OR 3.4, 95% CI (2.0-6.0); (3) diabetes, OR 2.1, 95% CI (1.2-3.8); (4) congestive heart failure (CHF), OR 2.8, 95% CI (1.3-6.5); (5) site of injury tibial shaft/plateau, OR 2.3, 95% CI (1.3-4.2); and (6) site of injury, elbow, OR 2.2, 95% CI (1.1-4.7). CONCLUSION The risk factors for SSIs after skeletal trauma are most strongly determined by nonmodifiable factors: patient infirmity (diabetes and heart failure) and injury complexity (site of injury, number of operations, use of a drain). LEVEL OF EVIDENCE Level II, prognostic study. See the Guideline for Authors for a complete description of levels of evidence.
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Is there a benefit to drains with a Kocher-Langenbeck approach? A prospective randomized pilot study. ACTA ACUST UNITED AC 2011; 69:1222-5. [PMID: 20375919 DOI: 10.1097/ta.0b013e3181bc78cb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Closed suction drainage is a routine part of wound management for patients undergoing surgical treatment of acetabulum fractures. This pilot study seeks to determine if there is a difference in wound healing for a Kocher-Langenbeck approach with and without the use of drains. METHODS We conducted a prospective, randomized study including 39 patients with acetabulum fractures treated through a Kocher-Langenbeck approach. During wound closure, patients were randomized into two groups: 20 patients (group I) received drains and 19 (group II) were closed without drains. All were followed up for drain output, quality and quantity of drainage, signs of infection, and duration of drainage. Patients were then evaluated at 2 weeks and 8 weeks for wound healing and any signs of infection. RESULTS By the 8-week follow-up, all wounds healed without any signs of infection. There was no difference in the average number of days of drainage between groups: 7.45 days and 7.95 days for group I and group II, respectively (p = 0.37). There were two wound complications (5.13%), with one in each group. Both complications consisted of cellulitis without signs of deep infection and had complete resolution with intravenous antibiotics. A post hoc power analysis determined that a test population of 1,264 patients would be needed to show a reduction in wound drainage time by 1 day. CONCLUSION With the numbers available in this pilot study, we showed no benefit to the use of drains for acetabular surgery performed through a Kocher-Langenbeck approach.
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Kanayama M, Oha F, Togawa D, Shigenobu K, Hashimoto T. Is closed-suction drainage necessary for single-level lumbar decompression?: review of 560 cases. Clin Orthop Relat Res 2010; 468:2690-4. [PMID: 20091386 PMCID: PMC3049608 DOI: 10.1007/s11999-010-1235-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 01/08/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications. QUESTIONS/PURPOSES We evaluated the efficacy of closed-suction drainage in single-level lumbar decompression surgery. PATIENTS AND METHODS We retrospectively reviewed 560 patients who underwent single-level lumbar decompression or discectomy. We routinely used closed-suction drainage in all spinal surgeries until July 2003, and thereafter, we did not use drains in single-level lumbar decompression surgery. These two groups (298 patients in the group that received drains, 262 in the group that did not receive drains) were compared for rates of wound infection and epidural hematoma. RESULTS Mean operating time (55 versus 56 minutes) and intraoperative blood loss (64 versus 57 mL) were not different between the two groups. None of 560 patients had a wound infection requiring surgical intervention. The rate of postoperative hematoma was 0.7% in the group that received drains (two of 298 patients) and 0% in the group that did not receive drains (zero of 262 patients). CONCLUSIONS In this study, the risk of wound infection and hematomas in single-level lumbar decompression surgery was not influenced by use of a drain. The use of postoperative wound drainage in patients with potential risk for epidural bleeding in situations such as multiple-level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases needs additional study. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Masahiro Kanayama
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585 Japan
| | - Fumihiro Oha
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585 Japan
| | - Daisuke Togawa
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585 Japan
| | - Keiichi Shigenobu
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585 Japan
| | - Tomoyuki Hashimoto
- Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido 040-8585 Japan
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Vaz K, Verma K, Protopsaltis T, Schwab F, Lonner B, Errico T. Bone grafting options for lumbar spine surgery: a review examining clinical efficacy and complications. SAS JOURNAL 2010; 4:75-86. [PMID: 25802654 PMCID: PMC4365636 DOI: 10.1016/j.esas.2010.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Iliac crest harvest has been considered the “gold standard” at producing successful arthrodesis of the lumbar spine but is also associated with many donor-site morbidities. Many alternatives have been used to avoid iliac crest harvest, including autologous bone from other donor sites, allogeneic bone, ceramics, and recombinant human bone morphogenetic proteins (rhBMPs). This review will highlight the properties and preparations of these graft types and their potential complications and reported clinical efficacy. Methods A Medline search was conducted via PubMed by use of the following terms in various combinations: lumbar fusion, freeze-dried allograft, fresh-frozen allograft, autograft, iliac crest, demineralized bone matrix, rhBMP-2, rhBMP-7, scoliosis, bone marrow aspirate, HEALOS, coralline hydroxyapatite, beta tricalcium phosphate, synthetic, ceramics, spinal fusion, PLF, PLIF, ALIF, and TLIF. Only articles written in English were assessed for appropriate material. Related articles were also assessed depending on the content of articles found in the original literature search. Conclusions Although iliac crest remains the gold standard, reported success with alternative approaches, especially in combination, has shown promise. Stronger evidence with limited sources of potential bias is necessary to provide a clear picture of their clinical efficacy.
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Affiliation(s)
- Kenneth Vaz
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Kushagra Verma
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Themistocles Protopsaltis
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Baron Lonner
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
| | - Thomas Errico
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases-Langone Medical Center, New York, NY
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Chou LB, Lee DC. Current concept review: perioperative soft tissue management for foot and ankle fractures. Foot Ankle Int 2009; 30:84-90. [PMID: 19176194 DOI: 10.3113/fai.2009.0084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Loretta B Chou
- Stanford University Medical Center, Department of Orthopaedic Surgery, 300 Pasteur Drive, Room R111, MC 5343, Stanford, CA 94305-5343, USA.
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Tejwani NC, Immerman I. Myths and legends in orthopaedic practice: are we all guilty? Clin Orthop Relat Res 2008; 466:2861-72. [PMID: 18726654 PMCID: PMC2565037 DOI: 10.1007/s11999-008-0458-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 08/04/2008] [Indexed: 01/31/2023]
Abstract
Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.
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Affiliation(s)
- Nirmal C Tejwani
- Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, NY 10016, USA.
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Abstract
The use of postsurgical drains have a long history in thoracic and abdominal surgery. In orthopedics these devices have been used to decrease local edema, lessen the potential for hematoma or seroma formation, and to aid in the efflux of infection. However, the role of postoperative surgical drains in clean, elective cases has not been firmly established. In fact, most studies fail to show a statistical difference in outcome between drained and undrained patients. Despite the paucity of clinical evidence demonstrating any benefit supporting their use, drains continue to be placed after elective orthopedic procedures.
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Affiliation(s)
- Robert J Gaines
- Department of Orthopedic Surgery, Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Virginia 23708, USA
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Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 2007; 2007:CD001825. [PMID: 17636687 PMCID: PMC8408575 DOI: 10.1002/14651858.cd001825.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of wound haematomas and infection. OBJECTIVES To evaluate the effectiveness of closed suction drainage systems for orthopaedic surgery. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), and contacted the Cochrane Wounds Group. We also searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), and MEDLINE (1966 to March 2006). Articles of all languages were considered. SELECTION CRITERIA All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of elective and emergency orthopaedic surgery. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality, using a nine item scale, and extracted data. Where appropriate, results of comparable studies were pooled. MAIN RESULTS Thirty-six studies involving 5464 participants with 5697 surgical wounds were identified. The types of surgery involved were hip and knee replacement, shoulder surgery, hip fracture surgery, spinal surgery, cruciate ligament reconstruction, open meniscectomy and fracture fixation surgery. Pooling of results indicated no statistically significant difference in the incidence of wound infection, haematoma, dehiscence or re-operations between those allocated to drains and the un-drained wounds. Blood transfusion was required more frequently in those who received drains. The need for reinforcement of wound dressings and the occurrence of bruising were more common in the group without drains. AUTHORS' CONCLUSIONS There is insufficient evidence from randomised trials to support the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials with larger patient numbers are required for different operations before definite conclusions can be made for all types of orthopaedic operations.
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Affiliation(s)
- M J Parker
- Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
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Jones BM, Grover R, Hamilton S. The Efficacy of Surgical Drainage in Cervicofacial Rhytidectomy: A Prospective, Randomized, Controlled Trial. Plast Reconstr Surg 2007; 120:263-270. [PMID: 17572574 DOI: 10.1097/01.prs.0000264395.38684.5a] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative drainage is often used instinctively in face lifting on the assumption that it may reduce the likelihood of complications. This potential benefit should be balanced against cost, discomfort, and the possibility of provoking bleeding and hematoma on removal. Evidence-based decisions on drainage are problematic, since no prospective studies have examined its role. This study was designed to address this issue directly. METHODS Fifty consecutive patients undergoing face lift over a 3-month period were randomized to drainage of one side of the face only, with the contralateral side serving as a paired control. Bruising, swelling, and hematoma or seroma were assessed objectively, independently of the operating surgeon and subjectively by the patients. RESULTS Postoperative hematoma and edema were not influenced by the use of drains (p > 0.5). Patients reported no difference between the two sides with respect to swelling (p = 0.6) or discomfort (p = 0.5). However, drains produced a statistically significant reduction in postoperative bruising both on clinical assessment (p = 0.005) and patient assessment (p = 0.002). CONCLUSIONS This article represents the first prospective, randomized, controlled trial assessing the use of postoperative drainage in facial rejuvenation surgery. Surgical drains do not influence postoperative complications, but they do significantly reduce bruising and so may facilitate the patient's return to normal activity.
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Affiliation(s)
- Barry M Jones
- London, United Kingdom From the King Edward VII's Hospital Sister Agnes
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Abstract
The best defense against postoperative infection is to use multiple strategies to minimize wound contamination, maintain wound tissue health, and provide rational antimicrobial strategies that do not promote the development of resistant bacteria and superinfections.
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Affiliation(s)
- Elizabeth M Santschi
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Drive Madison, Wisconsin 53706, USA.
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McCormack RG, Greenhow RJ, Fogagnolo F, Shrier I. Intra-articular drain versus no drain after arthroscopic anterior cruciate ligament reconstruction: a randomized, prospective clinical trial. Arthroscopy 2006; 22:889-93. [PMID: 16904589 DOI: 10.1016/j.arthro.2006.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. The usual reason given to justify the use of a drain is to minimize patient pain and stiffness of the knee joint. The purpose of this study was to assess the validity of this approach. METHODS In this study 118 consecutive ACL reconstruction patients were randomized to no drain or a postoperative intra-articular suction drain. Inclusion criteria included a successful ACL reconstruction via either 4-strand hamstrings or bone-patellar tendon-bone autograft as a graft source. The primary outcomes were defined as pain (assessed by pain scores and analgesic counts) and range of motion (ROM) (assessed by loss of flexion and extension compared with the nonoperative leg). An independent statistical analysis was performed. RESULTS The 2 groups were comparable with respect to patient demographics, surgical findings, and procedures performed. There were no differences between the treatment groups for the primary outcomes of pain and ROM during the 8-week follow-up period. The study had adequate power to detect a clinically significant difference. Regarding the secondary outcomes, there was a difference in the grade of hemarthrosis between the groups at week 1 but not at week 4 or 8. However, the difference in subjective grade of hemarthrosis at 1 week did not have any effect on the primary outcomes of pain and ROM. During the study period, there were no complications in either group. CONCLUSIONS The routine use of intra-articular drains after arthroscopic ACL surgery was not supported by this study. LEVEL OF EVIDENCE Level II, randomized controlled trial without narrow confidence intervals.
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Affiliation(s)
- Robert G McCormack
- Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada.
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Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trail. ACTA ACUST UNITED AC 2005; 58:286-9. [PMID: 15780221 DOI: 10.1016/j.bjps.2004.11.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2004] [Accepted: 11/12/2004] [Indexed: 10/25/2022]
Abstract
One hundred and fifty bilateral breast reductions were prospectively randomised intra-operatively to receive a unilateral wound drain. Seven patients required post-operative evacuation of haematoma, three on the drained and four on the undrained sides. There was no statistical difference in haematoma formation between drained and undrained sides (p = 1), or the incidence of wound healing or other complications. We believe that routine wound drainage in breast reduction surgery is an unnecessary intervention.
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Affiliation(s)
- N Collis
- Department of Plastic Surgery, St James's University Hospital, Leeds LS9 7FT, UK.
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Migaud H, Senneville E, Gougeon F, Marchetti E, Amzallag M, Laffargue P. Risque infectieux en chirurgie orthopédique. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.emcrho.2004.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tjeenk RM, Peeters MPV, van den Ende E, Kastelein GW, Breslau PJ. Wound drainage versus non-drainage for proximal femoral fractures. A prospective randomised study. Injury 2005; 36:100-4. [PMID: 15589927 DOI: 10.1016/j.injury.2004.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this prospective randomised study was to examine whether routine drainage in surgery for traumatic hip fractures is useful. BASIC PROCEDURES At the end of surgery for hip fractures, 200 consecutive patients (51 men, 149 women) were randomised to receive suction drainage or not. The status of wound healing was evaluated, with specific reference to haematoma formation or wound infection. Indices of blood loss were the average blood loss during operation, a decrease in the haemoglobin level, fluid collected by the drain, and blood transfusion. MAIN FINDINGS The severity of wound haematoma and the number of wound infections was not significantly different between the two groups. The average blood loss during operation was 172 ml in the drainage group and 179 ml in the non-drainage group. The volume of drainage fluid was 146 ml. The haemoglobin concentration decreased by 1.4 mg/dl in the drainage group and by 1.3 mg/dl in the non-drainage group (P = 0.83). During admission, 55 patients in the drainage group received 2.5 units of blood and 50 patients in the non-drainage group received 2.7 units. CONCLUSIONS The severity of wound haematoma does not lead to statistically significant differences in wound infection rate. The routine use of suction drains may not prevent wound infections.
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Affiliation(s)
- R M Tjeenk
- Department of Traumatology, Red Cross Hospital, The Hague, The Netherlands
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Blank J, Flynn JM, Bronson W, Ellman P, Pill SG, Lou JE, Dormans JP, Drummond DS, Ecker ML. The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis. ACTA ACUST UNITED AC 2004; 16:508-12. [PMID: 14657746 DOI: 10.1097/00024720-200312000-00004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this prospective study was to assess the impact of closed suction drainage on transfusion requirements, frequency of dressing changes, and wound healing following posterior spinal fusion in adolescents with idiopathic scoliosis. METHODS Thirty patients were randomly assigned to one of two groups: drain or no drain. Although the group with drains received more postoperative autologous blood transfusions than the group with no drains (0.88 vs 0.5 unit), the difference was not statistically significant (P = 0.2131). In the undrained group, 58% of the patients had moderate to completely saturated dressings on the second postoperative day compared with only 17% of patients in the drained group. Three of 12 patients in the undrained group demonstrated a wound complication rate compared with no complications in the drained group. CONCLUSION In conclusion, subcutaneous closed suction drainage can improve immediate postoperative wound care without significantly increasing blood loss and transfusion requirements for patients undergoing surgery for idiopathic scoliosis.
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Affiliation(s)
- John Blank
- Department of Orthopaedic Surgery, Cooper Hospital, Camden, NJ, USA
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Abstract
BACKGROUND The use of closed-suction drainage systems after total joint replacement is a common practice. The theoretical advantages for the use of drains is a reduction in the occurrence of wound hematomas and infection. The aim of this meta-analysis was to determine, on the basis of the evidence from randomized controlled trials, the advantages and adverse effects of surgical drains. METHODS All randomized trials, as far as we know, that compared patients managed with closed-suction drainage systems and those managed without a drain following elective hip and knee arthroplasty were considered. The trials were identified with use of searches of the Cochrane Collaboration with no restriction on languages or source. Two authors independently extracted the data, and the methods of all identified trials were assessed. RESULTS Eighteen studies involving 3495 patients with 3689 wounds were included in the analysis. The pooled results indicated that there was no significant difference between the wounds treated with a drain and those treated without a drain with respect to the occurrence of wound infection (relative risk, 0.73; 95% confidence interval, 0.47 to 1.14), wound hematoma (relative risk, 1.73; 95% confidence interval, 0.74 to 4.07), or reoperations for wound complications (relative risk, 0.52; 95% confidence interval, 0.13 to 1.99). A drained wound was associated with a significantly greater need for transfusion (relative risk, 1.43; 95% confidence interval, 1.19 to 1.72). Reinforcement of wound dressings was required more frequently in the group managed without drains. No difference between the groups was seen with respect to limb-swelling, venous thrombosis, or hospital stay. CONCLUSIONS Studies to date have indicated that closed suction drainage increases the transfusion requirements after elective hip and knee arthroplasty and has no major benefits. Further randomized trials with use of larger numbers of patients with full reporting of outcomes are indicated before the absence of any benefit, particularly for the outcome of wound infection, can be proved.
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Affiliation(s)
- Martyn J Parker
- Department of Orthopaedics and Trauma, Peterborough District Hospital, Peterborough, Cambridgeshire, England.
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Dhawan A, Doukas WC, Papazis JA, Scoville CR. Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Am J Sports Med 2003; 31:419-24. [PMID: 12750137 DOI: 10.1177/03635465030310031601] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little data exist on the effect of routine use of postoperative drainage after arthroscopic anterior cruciate ligament reconstruction, although clinical studies of other procedures have not shown benefit to this practice. HYPOTHESIS Use of a postoperative drain will not result in decreased suprapatellar girth, increased range of motion, and decreased pain compared with nonuse. STUDY DESIGN Prospective randomized clinical trial. METHODS Twenty-one patients undergoing arthroscopically assisted bone-patellar tendon-bone anterior cruciate ligament reconstruction were randomly assigned to receive a drain for 24 hours (12 patients) or no drain (9 patients). Data for comparison of groups were collected daily through postoperative day 7. RESULTS Pain scores on a visual analog scale demonstrated the same improving trend over time for both treatment and control groups; however, the treatment group had significantly higher average pain scores, except on day 7. Differences in suprapatellar girth, flexion, and extension were not found to be statistically significant between groups. CONCLUSION Use of a drain after arthroscopically assisted anterior cruciate ligament reconstruction provided no benefit in terms of range of motion, effusion, or pain in the early postoperative period.
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Affiliation(s)
- Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC. 20307, USA
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Abstract
BACKGROUND Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of wound haematomas and infection. OBJECTIVES To evaluate the effectiveness of closed suction drainage systems for orthopaedic surgery. SEARCH STRATEGY We searched the Cochrane Musculoskeletal Injuries Group specialised register (May 2001), MEDLINE (1996-May 2001) and references from articles. SELECTION CRITERIA All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of elective and emergency orthopaedic surgery. DATA COLLECTION AND ANALYSIS Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS Twenty-one studies involving 2772 patients with 2971 wounds were included in the analysis. The types of surgery involved were hip and knee replacement, shoulder surgery, hip fracture surgery, spinal surgery, cruciate ligament reconstruction, open meniscectomy and fracture fixation surgery. Many of the studies had poor methodology and reporting of outcomes. Pooling of results indicated no difference in the incidence of wound infection, haematoma or dehiscence between those allocated to drains and the un-drained wounds. There was a tendency to an increased risk of re-operation for wound complications in the group with drains (relative risk (RR) 2.25, 95% confidence intervals (CI) 0.95 to 5.33), but due to the small numbers of cases involved definite conclusions cannot be made for this outcome. Blood transfusion was required more frequently in those who received drains (RR 1.41, 95% CI 1.10 to 1.80). The need for reinforcement of wound dressings (RR 0.22, 95% CI 0.13 to 0.40) and bruising around the operation site was more common in the group without drains. REVIEWER'S CONCLUSIONS There is insufficient evidence from randomised trials to support or refute the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials are required before definite conclusions can be made.
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Affiliation(s)
- M J Parker
- Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA.
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