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Orthopaedic Surgery Dec 2020To investigate whether closed suction drainage (CSD) is related to accelerated rehabilitation of patients after open reduction and internal fixation (ORIF) for closed... (Randomized Controlled Trial)
Randomized Controlled Trial
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.
Topics: Adult; Aged; Female; Femoral Fractures; Fracture Fixation, Internal; Humans; Male; Middle Aged; Open Fracture Reduction; Pain Measurement; Postoperative Complications; Prospective Studies; Suction; Unnecessary Procedures
PubMed: 33047488
DOI: 10.1111/os.12812 -
BMC Nephrology May 2020To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of comparative studies.
METHOD
A comprehensive literature search was performed by PubMed, MEDLINE, Ovid and Web of Science for relevant studies published up to January 2020. The statistical analyses were conducted with Review Manager 5.3.0 and Stata 15.1. The sensitivity analysis was also carried out to confirm the reliability of this Meta-analysis.
RESULTS
Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that LD group was superior in symptomatic successful rate [Odds Ratio (OR): 0.28; 95%Confidence Interval (CI): 0.09 to 0.86; P = 0.03), radiological successful rate (OR: 0.06; 95%CI: 0.02 to 0.15; P < 0.01) and recurrence rate (OR: 6.08; 95%CI: 2.81 to 13.15; p < 0.01). Nevertheless, AS group had shorter treatment time [Mean Difference (MD):-51.10; 95% CI:-73.01 to - 29.20; p < 0.01]. No statistically significant difference was showed in the rate of complications (OR: 3.19; 95% CI: 0.39 to 25.88; P = 0.28).
CONCLUSIONS
In our meta-analysis, LD had higher symptomatic successful rate, radiological successful rate as well as lower recurrence rate than AS, while the treatment time was longer.
Topics: Cysts; Humans; Kidney Diseases; Laparoscopy; Operative Time; Recurrence; Sclerotherapy; Suction; Treatment Outcome
PubMed: 32448166
DOI: 10.1186/s12882-020-01832-7 -
International Journal of Surgery... Jul 2019There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical... (Meta-Analysis)
Meta-Analysis
Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis.
INTRODUCTION
There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage.
METHODS
The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF) rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT) was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95%CI)) as an effect measure was utilized.
RESULTS
Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD) were included. In meta-analysis of all studies, overall [OR (95%CI) = 0.81 (0.42, 1.56); p = 0.53; I = 79%; Tau = 0.54]; grade A [OR (95%CI) = 0.71 (0.33, 1.53); p = 0.39; I = 65%; Tau = 0.47]; grade B [OR (95%CI) = 1.23 (0.74, 2.05); p = 0.42; I = 0%]; and grade C [OR (95%CI) = 1.08 (0.56, 2.09); p = 0.82; I = 5%] POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI) = 1.55 (0.79, 3.04); p = 0.20; I = 0%]. No publication bias was found (t = 0.48; p = 0.64).
CONCLUSION
This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.
Topics: Drainage; Humans; Length of Stay; Odds Ratio; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Suction
PubMed: 31078675
DOI: 10.1016/j.ijsu.2019.05.001 -
Archivio Italiano Di Urologia,... Sep 2015In literature, most of the published data regarding prostatic abscess (PA) are case reports, whereas there is no standardization of the diagnostic and therapeutic... (Review)
Review
OBJECTIVES
In literature, most of the published data regarding prostatic abscess (PA) are case reports, whereas there is no standardization of the diagnostic and therapeutic routines. The purpose of this study is a new classification of ultrasound imaging of PA with clinical features correlation.
MATERIAL AND METHODS
We retrospectively analysed the ultrasound database archives and performed a MEDLINE® research of the peer reviewed literature on diagnosis and case reports of PA using the terms "prostate and abscess".
RESULTS
PA can be classified into five Types: Type I - PA is present focally in a prostate lobe (≤ 10 mm). Type II - PA is present in a prostate lobe (> 10 mm) and/or partially overcrosses the border of the midline prostatic glandular. Type III - PA is present in both glandular lobes form of multifocal areas (≤ 10 mm). Type IV - PA is present in both glandular lobes form of multifocal areas (> 10 mm). Type V - PA involving intra or extraprostatic structures (bladder, urethra, seminal vesicles and prostatic capsule). The different ultrasound imaging and diagnostic criteria are listed for each type and subtype.
CONCLUSIONS
The sonographic pattern of PA is usually characteristic and easily differentiated from other glandular lesions. The purpose of the study was to associate the use of TRUS to a clinical standardized classification in order to facilitate PA diagnosis and localization directing the clinician treatment to the correct management and adequate therapeutic treatment.
Topics: Abscess; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Male; Prostatic Diseases; Rectum; Suction; Treatment Outcome; Ultrasonography, Interventional
PubMed: 26428650
DOI: 10.4081/aiua.2015.3.246 -
Scientific Reports Jan 2023The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal...
The aim of current single-center study was to compare the short-term outcome of suction and gauze wiping alone versus the irrigation and suction technique for peritoneal decontamination among patients who underwent laparoscopic repair of PPU. Using data from our institution's prospectively maintained database, 105 patients who underwent laparoscopic repair were enrolled in this study. The participants were further divided into the group who received peritoneal irrigation (irrigation group, n = 67) and group who received gauze wiping and suction only (suction only group, n = 38). The irrigation group had a longer operative time (140 vs. 113 min, p = 0.0001), higher number of drainage tubes (38.8% vs. 0%, p < 0.0001) and a higher incidence of intra-abdominal abscess (10.4% vs. 0%, p = 0.0469) than the suction only group. Peritoneal irrigation may be associated with a prolonged operative time and a higher number of abdominal drains. Meanwhile, gauze wiping and suction may be sufficient for peritoneal decontamination during the laparoscopic repair of PPU as further infectious complications are not observed.
Topics: Humans; Suction; Decontamination; Treatment Outcome; Laparoscopy; Peptic Ulcer Perforation; Postoperative Complications
PubMed: 36670125
DOI: 10.1038/s41598-023-27471-0 -
Interactive Cardiovascular and Thoracic... May 2021A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: what is the optimal level of suction on digital...
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: what is the optimal level of suction on digital chest drainage devices following pulmonary lobectomy? Altogether 367 papers were found using the reported search, of which 4 randomized controlled trials using digital chest drainage devices represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The new digital drainage systems enhance early mobilization as recommended in the enhanced recovery after surgery programme. There is, however, no consensus on the optimal level of suction to apply after pulmonary lobectomy. This is especially the case for digital drainage devices. Surgeon preference will likely continue to guide practice, until the evidence gives clear-cut recommendations. According to the current data, a low suction reduces total fluid drainage and perhaps air leak duration compared to higher suction levels in both video-assisted thoracoscopic surgery and open pulmonary lobectomies using digital drainage devices, although the evidence is not overwhelming.
Topics: Benchmarking; Chest Tubes; Drainage; Humans; Length of Stay; Pneumonectomy; Suction; Thoracic Surgery, Video-Assisted; Time Factors; Treatment Outcome
PubMed: 33569581
DOI: 10.1093/icvts/ivab028 -
BMC Musculoskeletal Disorders Aug 2021The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis.
METHODS
In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days.
RESULTS
The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group.
CONCLUSIONS
We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings.
TRIAL REGISTRATION
The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.
Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Drainage; Humans; Postoperative Complications; Prospective Studies; Retrospective Studies; Suction; Venous Thromboembolism
PubMed: 34389016
DOI: 10.1186/s12891-021-04583-0 -
The Journal of the Oklahoma State... 2016Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has... (Review)
Review
Oronasopharyngeal suction (ONPS) is regularly performed in neonates at delivery in many hospitals across the country today. Although ONPS is a technique that has essentially become habitual for most obstetricians, its theorized usefulness to help promote expeditious lung aeration after delivery by removal of amniotic fluid, meconium, mucus and blood that may otherwise be aspirated by the newborn, is currently not recommended. ONPS can cause vagal stimulation-induced bradycardia and thus hypercapnea, iatrogenic infection due to mucous membrane injury, and development of subsequent neonatal brain injury due to changes in cerebral blood flow regulation, particularly in premature infants. Multiple studies that have been performed comparing routine use of ONPS to no intervention controls indicate that newborns receiving ONPS took a longer time to achieve normal oxygen saturations, caused apneic episodes, and caused disturbances in heart rate (mainly bradycardia) compared to the control groups. Although the ONPS groups revealed no significantly different APGAR scores at 1 and 5 minutes, the ONPS groups took longer than the control group to reach an arterial oxygen saturation greater than or equal to 92% in the first minutes of life. Currently, Neonatal Resuscitation Program guidelines discourage the use of or meconium-stained amniotic fluid and in the absence of obvious obstruction. Furthermore, this manuscript highlights various literature sources revealing that the routine use of ONPS at the time of delivery can cause more harm than good, if any good at all.
Topics: Delivery, Obstetric; Drainage; Humans; Infant, Newborn; Practice Guidelines as Topic; Respiratory System; Suction
PubMed: 27328554
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... May 2017No rational argument leads to conclude to the benefit or the innocuousness of drainage in non-septic wrist surgery.
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.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Plates; Child; Child, Preschool; Device Removal; Female; Fracture Fixation, Internal; Humans; Infant; Male; Middle Aged; Radius Fractures; Reoperation; Retrospective Studies; Suction; Wrist; Wrist Injuries; Young Adult
PubMed: 28163242
DOI: 10.1016/j.otsr.2017.01.002 -
The Cochrane Database of Systematic... Mar 2016Endotracheal suctioning consists of the mechanical aspiration of pulmonary secretions from the endotracheal tube (ETT) to prevent obstruction. The optimal frequency of... (Review)
Review
BACKGROUND
Endotracheal suctioning consists of the mechanical aspiration of pulmonary secretions from the endotracheal tube (ETT) to prevent obstruction. The optimal frequency of ETT suctioning has not been defined.
OBJECTIVES
To determine the effect of specific ordered frequency of ETT suctioning ('as scheduled') versus ETT suctioning only in case of indications ('as needed') and of more frequent ETT suctioning versus less frequent ETT suctioning on respiratory morbidity in ventilated newborns.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 10), MEDLINE via PubMed (1966 to 31 October 2015), EMBASE (1980 to 31 October 2015), and CINAHL (1982 to 31 October 2015). We checked the reference lists of retrieved articles and contacted study authors to identify additional studies. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials.
SELECTION CRITERIA
Randomized, quasi-randomized, and cluster randomized controlled trials comparing different strategies regarding the frequency of ETT suctioning of newborn infants receiving ventilator support.
DATA COLLECTION AND ANALYSIS
We used the standard methods of the Cochrane Neonatal Review Group. Two review authors independently extracted data and assessed the risk of bias of trials. The primary outcome was bronchopulmonary dysplasia or chronic lung disease.
MAIN RESULTS
We identified one randomized controlled study recruiting 97 low birthweight infants that met the inclusion criteria. The study was conducted in the UK in 1987 and 1988. Randomized infants received ETT suctioning every six or 12 hours during the first three days of life. The quality of reporting was limited and we rated the trial at high risk of bias. Furthermore, the trial lacked adequate power. There were no statistically significant differences in any of reported outcomes: bronchopulmonary dysplasia (defined as oxygen at more than 30 days; risk ratio (RR) 0.49, 95% confidence interval (CI) 0.20 to 1.20); incidence of pneumothorax (RR 0.70, 95% CI 0.24 to 2.05); intraventricular hemorrhage (RR 1.12, 95% CI 0.44 to 2.85); neonatal death (RR 1.40, 95% CI 0.58 to 3.37); and time on ventilation (median time 39 hours in the 12-hourly group and 28 hours in the six-hourly group; RD not applicable for this outcome as mean and standard deviation were not reported). Tests for heterogeneity were not applicable as only one study was included.
AUTHORS' CONCLUSIONS
There was insufficient evidence to identify the ideal frequency of ETT suctioning in ventilated neonates. Future research should focus on the effects in the very preterm newborns, that is, the most vulnerable population as concerns the risk of both lung and brain damage. Assessment should include the cases of prolonged ventilation, when more abundant, dense secretions are common. Clinical trials might include comparisons between 'as-scheduled' versus 'as-needed' endotracheal suctioning, that is, based on specific indications, as well frequent versus less frequent suctioning schedules.
Topics: Catheter Obstruction; Humans; Infant, Low Birth Weight; Infant, Newborn; Intubation, Intratracheal; Lung; Randomized Controlled Trials as Topic; Respiration, Artificial; Suction; Time Factors
PubMed: 26945780
DOI: 10.1002/14651858.CD011493.pub2