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Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions.

Poorman CE, Passias PG, Bianco KM, Boniello A, Yang S, Gerling MC - Int J Spine Surg (2014)

Bottom Line: Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not.The study population included 39 patients who received a postoperative drain and 42 patients who did not.While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York.

ABSTRACT

Background: Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. The objective of this retrospective case-control series is to investigate the effectiveness of postoperative drains following one- and two-level cervical fusions.

Methods: A chart review was conducted at a single institution from 2010-2013. Outcome measures included operative time, hospital stay, estimated blood loss and incidence of wound complications (infection, hematoma, edema, and complications with wound healing or evacuation), respiratory complications (delayed extubation, re-intubation, and respiratory treatment), and overall complications (wound complications, respiratory complications, dysphagia, and other complications). Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not.

Results: The study population included 39 patients who received a postoperative drain and 42 patients who did not. There were no differences in demographics between the two groups. Patients with drains showed increased operative time (100.1 vs 69.3 min, p < 0.001), hospital stay (38.9 vs. 31.7 hrs, p = 0.021), and blood loss (62.7 vs 29.1 mL, p < 0.001) compared to patients without drains. The frequency of wound complications, respiratory complications, and overall complications did not vary significantly between groups.

Conclusions/level of evidence: Cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay.

Clinical relevance: This could contribute to excessive costs for patients treated with drains, despite the lack of compelling evidence of the advantages of this treatment in the literature and in the current study.

No MeSH data available.


Related in: MedlinePlus

Intraoperative fluoroscopy performed after a C4-C5 anterior decompression and fusion on a 44 year old female presenting with herniated nucleus pulposus and radiculopathy. Patient received a postoperative JP drain. Minimal peri-incisional edema and sinus bradycardia noted on postoperative day 0 (POD0). On POD1 patient was noted to be complaining of chest pain, hoarseness and difficulty swallowing.
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Figure 0001: Intraoperative fluoroscopy performed after a C4-C5 anterior decompression and fusion on a 44 year old female presenting with herniated nucleus pulposus and radiculopathy. Patient received a postoperative JP drain. Minimal peri-incisional edema and sinus bradycardia noted on postoperative day 0 (POD0). On POD1 patient was noted to be complaining of chest pain, hoarseness and difficulty swallowing.

Mentions: The frequency of overall complications, wound complications, and respiratory complications did not vary significantly between the two groups (Table 3). Overall complications occurred in 41.0% of the drain group and 45.2% of the no drain group (p = 0.70). Though this difference was not statistically significant, patients with postoperative drains developed slightly less overall complications than patients without drains (OR = 0.84). Wound complications occurred in 7.5% of patients in the drain group and 7.1% of patients in the no drain group (p = 0.93). Patients with drains developed slightly more wound complications (OR = 1.08) than patients without drains. In the drain group, there was a trend towards more complications with wound healing (5.1% vs. 0.0%, p = 0.14), however, there was less infection (0.0% vs. 2.4%, p = 0.33) and edema (2.6% vs 4.8%, p = 0.60), although these differences were not significant. Hematoma and wound evacuation did not occur in any patients in either group. Respiratory complications occurred in 17.9% of the drain group and 16.7% of the no drain group (p = 0.88). Patients with drains trended towards slightly more respiratory complications that patients without drains (OR = 1.09). The drain group trended towards higher rates of re-intubation (5.1% vs. 0.0%, p = 0.14) and respiratory treatment (17.9% vs. 16.7%, p = 0.88) than the no-drain group. Delayed extubation did not occur in any of the study patients. Finally, dysphagia (15.4% vs. 9.5%, p = 0.42) and all other complications (30.8% vs. 26.2%, p = 0.65) were more frequent in the drain group, although these differences were not statistically significant (Figure 1).


Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions.

Poorman CE, Passias PG, Bianco KM, Boniello A, Yang S, Gerling MC - Int J Spine Surg (2014)

Intraoperative fluoroscopy performed after a C4-C5 anterior decompression and fusion on a 44 year old female presenting with herniated nucleus pulposus and radiculopathy. Patient received a postoperative JP drain. Minimal peri-incisional edema and sinus bradycardia noted on postoperative day 0 (POD0). On POD1 patient was noted to be complaining of chest pain, hoarseness and difficulty swallowing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325495&req=5

Figure 0001: Intraoperative fluoroscopy performed after a C4-C5 anterior decompression and fusion on a 44 year old female presenting with herniated nucleus pulposus and radiculopathy. Patient received a postoperative JP drain. Minimal peri-incisional edema and sinus bradycardia noted on postoperative day 0 (POD0). On POD1 patient was noted to be complaining of chest pain, hoarseness and difficulty swallowing.
Mentions: The frequency of overall complications, wound complications, and respiratory complications did not vary significantly between the two groups (Table 3). Overall complications occurred in 41.0% of the drain group and 45.2% of the no drain group (p = 0.70). Though this difference was not statistically significant, patients with postoperative drains developed slightly less overall complications than patients without drains (OR = 0.84). Wound complications occurred in 7.5% of patients in the drain group and 7.1% of patients in the no drain group (p = 0.93). Patients with drains developed slightly more wound complications (OR = 1.08) than patients without drains. In the drain group, there was a trend towards more complications with wound healing (5.1% vs. 0.0%, p = 0.14), however, there was less infection (0.0% vs. 2.4%, p = 0.33) and edema (2.6% vs 4.8%, p = 0.60), although these differences were not significant. Hematoma and wound evacuation did not occur in any patients in either group. Respiratory complications occurred in 17.9% of the drain group and 16.7% of the no drain group (p = 0.88). Patients with drains trended towards slightly more respiratory complications that patients without drains (OR = 1.09). The drain group trended towards higher rates of re-intubation (5.1% vs. 0.0%, p = 0.14) and respiratory treatment (17.9% vs. 16.7%, p = 0.88) than the no-drain group. Delayed extubation did not occur in any of the study patients. Finally, dysphagia (15.4% vs. 9.5%, p = 0.42) and all other complications (30.8% vs. 26.2%, p = 0.65) were more frequent in the drain group, although these differences were not statistically significant (Figure 1).

Bottom Line: Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not.The study population included 39 patients who received a postoperative drain and 42 patients who did not.While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York.

ABSTRACT

Background: Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. The objective of this retrospective case-control series is to investigate the effectiveness of postoperative drains following one- and two-level cervical fusions.

Methods: A chart review was conducted at a single institution from 2010-2013. Outcome measures included operative time, hospital stay, estimated blood loss and incidence of wound complications (infection, hematoma, edema, and complications with wound healing or evacuation), respiratory complications (delayed extubation, re-intubation, and respiratory treatment), and overall complications (wound complications, respiratory complications, dysphagia, and other complications). Statistical analyses including independent samples t-test, chi-square, analysis of covariance, and linear regression were used to compare patients who received a postoperative drain to those who did not.

Results: The study population included 39 patients who received a postoperative drain and 42 patients who did not. There were no differences in demographics between the two groups. Patients with drains showed increased operative time (100.1 vs 69.3 min, p < 0.001), hospital stay (38.9 vs. 31.7 hrs, p = 0.021), and blood loss (62.7 vs 29.1 mL, p < 0.001) compared to patients without drains. The frequency of wound complications, respiratory complications, and overall complications did not vary significantly between groups.

Conclusions/level of evidence: Cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between groups, patients treated with drains had significantly longer operative time and length of hospital stay.

Clinical relevance: This could contribute to excessive costs for patients treated with drains, despite the lack of compelling evidence of the advantages of this treatment in the literature and in the current study.

No MeSH data available.


Related in: MedlinePlus