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Wang C, Wang X, Yang Z, Shi J, Niu N. Comparative study on the selection of drainage methods in posterior lumbar interbody fusion. BMC Surg 2023; 23:207. [PMID: 37480018 PMCID: PMC10362626 DOI: 10.1186/s12893-023-02106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To compare and analyze the clinical effects of bilateral natural pressure drainage and negative pressure drainage after posterior lumbar interbody fusion (PLIF) to provide a reference for selecting drainage methods after lumbar surgery. METHODS A retrospective cohort study, 281 patients who underwent single-segment PLIF in our hospital from January 2017 to December 2020 and met the inclusion and exclusion criteria were included in the study, including 132 males and 149 females, aged 22-85 years, with an average of (53.62 ± 11.23) years. According to different postoperative incision drainage methods determined by the random number table method before surgery, they were divided into the natural pressure drainage group and negative pressure drainage group, both of which were bilateral drainage. The general observation indexes and perioperative-related indexes were recorded and analyzed. RESULTS There were 143 cases in the natural pressure drainage group and 138 cases in the negative pressure drainage group. There was no significant difference in age, gender, body mass index, disease type, blood pressure on the day of surgery, preoperative albumin, hemoglobin, platelet, prothrombin time, and intraoperative bleeding between the two groups (P > 0.05). The albumin on the first postoperative day in the natural pressure drainage group was higher than that in the negative pressure drainage group [(33.24 ± 3.52) vs. (32.17 ± 5.03), P < 0.05]; The hemoglobin on the first postoperative day in the natural pressure drainage group was higher than that in the negative pressure drainage group [(126.01 ± 15.03) vs. (115.19 ± 16.25), P < 0.01]; The drainage volume on the first postoperative day in the natural pressure drainage group was lower than that in the negative pressure drainage group [(93.25 ± 63.58) ml vs. (119.46 ± 54.48) ml, P < 0.01]; The total postoperative drainage volume in the natural pressure drainage group was lower than that in the negative pressure drainage group [(355.60 ± 189.69) ml vs. (434.37 ± 149.12) ml, P < 0.01]; The indwelling time of drainage tube in the natural pressure drainage group was lower than that in the negative pressure drainage group [(3.29 ± 1.17) d vs. (3.45 ± 0.97) d, P < 0.05]. There was no significant difference in platelet count on the first postoperative day, postoperative hospital stays, and complications (incision infection and hematoma) between the two groups (P > 0.05). CONCLUSION Bilateral natural pressure drainage and negative pressure drainage can achieve good drainage effects after PLIF, but patients with natural pressure drainage have less loss of albumin and hemoglobin, less drainage volume, and shorter drainage tube indwelling time, which is worthy of clinical application.
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Affiliation(s)
- Chaoran Wang
- Department of Orthopedics, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Xuewei Wang
- Medical Record Room, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zongqiang Yang
- Department of Orthopedics, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Jiandang Shi
- Department of Orthopedics, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China
| | - Ningkui Niu
- Department of Orthopedics, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China.
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Molina M, Torres R, Castro M, Gonzáles L, Weissmann K, Martinez M, Ganga M, Postigo R. Wound drain in lumbar arthrodesis for degenerative disease: an experimental, multicenter, randomized controlled trial. Spine J 2023; 23:473-483. [PMID: 36509378 DOI: 10.1016/j.spinee.2022.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Drains for surgical wound management are frequently used in spine surgery. They are often used to decrease the incidence of postoperative hematoma and decrease wound tension. No conclusive evidence in the literature supports using drains to avoid complications in degenerative lumbar spine surgery. PURPOSE We aimed to evaluate wound drains in patients with lumbar arthrodesis for degenerative disorders based on clinical outcomes, complications, hematocrit, and length of stay. STUDY DESIGN A multicenter randomized prospective controlled clinical trial. PATIENT SAMPLE We enrolled surgical candidates for posterior lumbar decompression and fusion surgery for degenerative disorders from October 2019 to August 2021. Patients were randomized into the drain or nondrain group at nine hospitals. The inclusion criteria were as follows: patients aged 40 to 80 years with lumbar and radicular pain, lumbar degenerative disorder, and primary surgery up to three levels. The exclusion criteria were bleeding abnormalities, bleeding >2,500 mL and dural tears. OUTCOME MEASURES Preoperative data including Oswestry disability index (ODI), SF-36, lumbar and lower extremity visual analog scale (VAS), body mass index (BMI), hematocrit, and temperature were recorded. Surgical parameters, including surgical time, complications, estimated blood loss (EBL), postoperative temperature and hematocrit (days 1 and 4), dressing saturation, and length of hospital stay (LOS), were registered. METHODS The two groups were assessed preoperatively, perioperatively and at the 1-month follow-up. A REDCap database was used for registration. Data analysis was performed using classical statistics. RESULTS One hundred one patients were enrolled using the Redcap database, and 93 patients were evaluated at the final follow-up. Forty-five patients were randomized to the drain group, and 48 were randomized to the nondrain group. The preoperative characteristics were equivalent in both groups: demographic aspects, pain, ODI, SF-36, BMI, hematocrit, and spine pathology. Surgical time, EBL and complications were similar, with no difference between the groups. No difference was found between BMI and complications. No difference was observed in dressing saturation or postoperative temperature between the groups. The postoperative day 4 hematocrit was higher in the nondrain group [36.4% (32-39)] than in the drain group [34% (29.7-37.6)] without statistically differences (p=.054). The LOS was higher in the drain group [4 (3-5) days] than in the nondrain group [3 (2-4) days] (p=.007). The quality-of-life score, SF-36, was higher in the nondrain group [67.9 (53.6-79.2)] than in the drain group [56.7 (49.1-66)] (p=.043). CONCLUSIONS Nondrain patients presented shorter LOS and better outcomes, with similar complication rates. No difference was found between BMI and complications. Based on this study, in patients undergoing primary posterior spinal decompression and fusion up to three levels for degenerative lumbar disorders, we do not recommend the use of postoperative drains.
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Affiliation(s)
- Marcelo Molina
- Department of Orthopaedic Surgery, Spine Center, Clínica Las Condes, Santiago, Chile; Instituto Traumatológico de Santiago, Santiago, Chile; Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile.
| | - Ramón Torres
- Instituto Traumatológico de Santiago, Santiago, Chile; Department of Orthopaedic Surgery, Clínica Santa Maria, Santiago, Chile
| | - Magdalena Castro
- Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile
| | | | | | - Maripaz Martinez
- Research and Clinical Epidemiology Unit, Finis Terrae University, Santiago, Chile
| | - Marcos Ganga
- Department of Orthopaedic Surgery, Clínica Santa Maria, Santiago, Chile
| | - Roberto Postigo
- Department of Orthopaedic Surgery, Clínica Universidad de los Andes, Santiago, Chile
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Reier L, Fowler JB, Arshad M, Siddiqi J. Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage. Cureus 2022; 14:e23129. [PMID: 35464540 PMCID: PMC9001810 DOI: 10.7759/cureus.23129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022] Open
Abstract
No guidelines currently exist for surgeons to follow regarding drain use after spine surgery for degenerative disc disease. Therefore, we conducted a literature review to determine what situations warrant drain placement versus those which do not. When placed, we further investigate optimal drain duration. The goal of this article is to provide spine surgeons insight into the current literature and guidance when deciding if a drain should be used or discontinued. We performed a PubMed search and analyzed 44peer-reviewed journal articles. Only studies that had the full article available were included. The highest-quality studies that were reviewed, demonstrated that in most situations using a drain is not associated with superior outcomes. It revealed that when drains are retained for a longer duration they run a greater risk of surgical site infection (SSI). Additionally, drains are associated with increased blood loss, a greater chance of requiring blood transfusions, and longer hospital stays. We conclude that drains are currently being overused in spine surgery for cases of degenerative disc disease, which exposes patients to unnecessary complications while providing minimal benefit.
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Schnake KJ, Pumberger M, Rappert D, Götz A, Zolotoverkh O, Waligora R, Scheyerer MJ. Closed-suction drainage in thoracolumbar spinal surgery-clinical routine without evidence? a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:614-622. [PMID: 35092451 DOI: 10.1007/s00586-021-07079-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The considered benefit of surgical drain use after spinal surgery is to prevent local accumulation of a haematoma by decompressing the closed space in the approach of the surgical site. In this context, the aim of the present systematic review was to prove the benefit of the routine use of closed-suction drains. METHODS We conducted a comprehensive systematic review of the literature according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and algorithm. RESULTS Following the literature search, 401 potentially eligible investigations were identified. Eventually, a total of 24 studies with 8579 participants were included. Negative suction drainage led to a significantly higher volume of drainage fluid. Drainage duration longer than 72 h may be associated with a higher incidence of Surgical side infections (SSI); however, accompanying antibiotic treatment is unnecessary. Regarding postoperative haematoma and neurological complications, no evidence exists concerning their prevention. Hospital stay length and related costs may be elevated in patients with drainage but appear to depend on surgery type. CONCLUSIONS With regard to the existing literature, the use of closed-suction drainage in elective thoracolumbar spinal surgery is not associated with any proven benefit for patients and cannot decrease postoperative complications.
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Affiliation(s)
- Klaus John Schnake
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany.,Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Matthias Pumberger
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Denis Rappert
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Achim Götz
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Oleksandr Zolotoverkh
- Center for Spine and Scoliosis Therapy, Malteser Waldkrankenhaus St.,Marien, Erlangen, Germany
| | - Rita Waligora
- Spine Department, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Max Joseph Scheyerer
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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Lim S, Bazydlo M, Macki M, Haider S, Schultz L, Nerenz D, Fadel H, Pawloski J, Yeh HH, Park P, Aleem I, Khalil J, Easton R, Schwalb JM, Abdulhak M, Chang V. A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. Spine (Phila Pa 1976) 2022; 47:220-226. [PMID: 34516058 DOI: 10.1097/brs.0000000000004169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective, cohort analysis of multi-institutional database. OBJECTIVE This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries. SUMMARY OF BACKGROUND DATA After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement. METHODS The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation. RESULTS We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured. CONCLUSION Our analysis demonstrated that drain use is associated with significant longer hospital stay.Level of Evidence: 3.
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Affiliation(s)
- Seokchun Lim
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Michael Bazydlo
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - Mohamed Macki
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Sameah Haider
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Lonni Schultz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Department of Public Health Services, Henry Ford Hospital, Detroit, MI
| | - David Nerenz
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Hassan Fadel
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Jacob Pawloski
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Hsueh-Han Yeh
- Center for Health Services Research, Henry Ford Hospital, Detroit, MI
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | - Ilyas Aleem
- Department of Orthopaedics, University of Michigan, Ann Arbor, MI
| | - Jad Khalil
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Richard Easton
- Department of Orthopaedics, William Beaumont Hospital, Royal Oak, MI
| | - Jason M Schwalb
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Muwaffak Abdulhak
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
| | - Victor Chang
- From the Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI
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Are Subfascial Drains Necessary to Prevent Airway Complications Following Anterior Cervical Discectomy and Fusion? Clin Spine Surg 2020; 33:5-8. [PMID: 31220041 DOI: 10.1097/bsd.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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