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Foot & Ankle International Sep 2022The purpose of this study is to determine whether the use of closed suction drains after total ankle arthroplasty (TAA) is associated with lower wound complications in...
BACKGROUND
The purpose of this study is to determine whether the use of closed suction drains after total ankle arthroplasty (TAA) is associated with lower wound complications in the first postoperative year as compared to no drain usage.
METHODS
A total of 324 TAA were reviewed and included for analysis. One hundred forty-four did not have a postoperative drain placed, whereas 180 did have a postoperative drain. Demographic data, including age, sex, tobacco or alcohol use, and various medical comorbidities, were obtained. Follow-up data were collected and reviewed at 2, 6, and 12 weeks; 6 months; and 1 year postoperatively for minor and major wound complications, as well as wound-related reoperations.
RESULTS
At the 2-week mark, the use of a drain demonstrated a significant increase in wound complications. No significant difference in wound complications was found at each subsequent follow-up visit. Within the first postoperative year, a total of 46 patients (31.9%) without drains and 69 patients (38.3%) with drains had a wound complication. This was not statistically significant. Most wound complications were minor, and no significant difference in reoperation rates occurred between the 2 groups.
CONCLUSION
A postoperative closed suction drain may increase wound complications in the first 2 weeks after TAA and should therefore be used with caution.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Ankle; Arthroplasty, Replacement, Ankle; Drainage; Humans; Postoperative Complications; Retrospective Studies; Suction
PubMed: 35723260
DOI: 10.1177/10711007221099197 -
International Orthopaedics Apr 2015The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA.
METHODS
Six randomised controlled trials were included.
RESULTS
There is no significant difference between the individuals who receive a drain and those who do not across any of the measures examined (p < 0.05). This analysis demonstrates no statistical difference in ROM [mean difference 0.03° (95 %CI -1.51 to 1.45, p = 0.64, I(2) = 0 %)]. , nor in knee circumference [mean difference 1.63 cm (95 % CI -1.07 - 4.34 cm, p = 0.34), [I(2) = 0.12].
CONCLUSION
The finding raises the possibility that drains are not required to assist in recovery following TKA.
Topics: Arthroplasty, Replacement, Knee; Drainage; Female; Humans; Knee Joint; Length of Stay; Male; Osteoarthritis, Knee; Postoperative Period; Recovery of Function; Suction; Treatment Outcome
PubMed: 25027980
DOI: 10.1007/s00264-014-2455-2 -
Shanghai Kou Qiang Yi Xue = Shanghai... Jun 2014To evaluate the efficacy and safety of closed suction drainage for prevention of postoperative complications after parotidectomy. (Review)
Review
PURPOSE
To evaluate the efficacy and safety of closed suction drainage for prevention of postoperative complications after parotidectomy.
METHODS
Pubmed, Cochrane Controlled Trials Register, Embase, Open Sigle, CBM, VIP and Wanfang database were searched electronically from the date of their establishment to May 10,2013. Hand-searching covering 19 relevant Chinese journals were also performed, and the literature of randomized controlled trials comparing closed suction drainage and open drainage for prevention of postoperative complications after parotidectomy were included. Risk of bias assessment, which was suggested by Cochrane handbook for systematic reviewers of intervention review, and data extraction of included studies were delivered by two reviewers in duplicate; and meta analysis was performed with Revman 5.2 software.
RESULTS
Ten randomized controlled trials were included. All studies had unclear risk of bias. When compared with open drainage, closed suction drainage showed a significant advantage on reducing postoperative complications (salivary fistula/effusion, edema) after parotidectomy; it also improved clinical comprehensive effect and patients' quality of life (P<0.05).
CONCLUSIONS
To a certain extent, closed suction drainage has better efficacy and safety than controls in preventing postoperative complications after parotidectomy. However, as the quality of some included studies is limited, more randomized controlled trials are needed to reinforce the conclusion.
Topics: Drainage; Humans; Parotid Gland; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Suction
PubMed: 25102886
DOI: No ID Found -
The British Journal of Surgery Nov 1981
Topics: Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestine, Small; Suction
PubMed: 6975149
DOI: 10.1002/bjs.1800681116 -
British Journal of Neurosurgery Feb 2024A retrospective study was conducted to compare gravity drainage and suction drainage after cervical laminoplasty.
OBJECTIVES
A retrospective study was conducted to compare gravity drainage and suction drainage after cervical laminoplasty.
PATIENTS AND METHODS
A total of 375 patients who underwent laminoplasty between January 2011 and December 2015 were engaged in this analysis. We investigated the patients' basic characteristics, drainage characteristics and postoperative complications.
RESULTS
During the initial 24 h after laminoplasty, the drainage volume in the suction drainage group was 177.31 ± 92.02 mL, and the drainage volume in the gravity drainage group was 133.33 ± 92.40 mL. The drainage volume showed significant difference ( < 0.01). The total drainage volume was 357.49 ± 195.16 mL and 250.16 ± 27.44 mL in the suction drainage group and gravity drainage group, respectively. The total drainage volume between the two groups was statistically different ( = 0.03). The postoperative Hb was significantly different between the gravity group and suction group on the first day after the operation (108.37 ± 23.92 mL vs. 87.32 ± 21.53 mL, = 0.02). The number of patients required blood transfusion was significantly different between the two groups as well ( = 0.04). Two cases had symptomatic epidural hematomas (SEH) after laminoplaty. However, the occurrence of SEH among the two groups was not different significantly. Twelve patients had surgical site infection (SSI). Of these 12, nine had applied gravity drainage and three suction drainage. The rate of SSI was similar between the two groups ( = 0.71).
CONCLUSION
The initial 24 h' drainage volume and the total drainage volume increased significantly in the suction drainage group. The postoperative Hb was lower in the suction group than the gravity drainage group the first postoperative day. More patients needed blood transfusion if suction drainage was performed. The application of suction drainage cannot decrease the incidence of SSI and SEH after laminoplasty. Gravity drainage is recommended for laminoplasty.
Topics: Humans; Suction; Retrospective Studies; Laminoplasty; Cohort Studies; Drainage; Surgical Wound Infection
PubMed: 34608847
DOI: 10.1080/02688697.2021.1900538 -
Orthopedics Nov 1992Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains... (Review)
Review
Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the non-drained group (P < .025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.
Topics: Aged; Blood Transfusion; Drainage; Female; Hemoglobins; Hip Prosthesis; Humans; Male; Middle Aged; Osteoarthritis, Hip; Postoperative Care; Retrospective Studies; Suction; Surgical Wound Infection
PubMed: 1461814
DOI: 10.3928/0147-7447-19921101-11 -
The Cochrane Database of Systematic... 2001Closed 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... (Review)
Review
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.
Topics: Hematoma; Humans; Postoperative Complications; Randomized Controlled Trials as Topic; Suction; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 11687125
DOI: 10.1002/14651858.CD001825 -
Zeitschrift Fur Die Gesamte Hygiene Und... Feb 1990After the introduction of Redon high-vacuum drainage, a considerable decrease in post-operative haematomas has been noted. But some of the complications could not be... (Comparative Study)
Comparative Study Review
After the introduction of Redon high-vacuum drainage, a considerable decrease in post-operative haematomas has been noted. But some of the complications could not be prevented by using the Redon system. They were in fact the result of it. The Redon system cannot be classified as a "closed" wound drainage. During bottle replacement, the system must be disconnected. An effective closed system must remain absolutely tight from application to removal of the drain so no possibility exists of contamination infection from the outside. After introduction of a continuously absolutely closed system in a prospective study with 3 different systems the influence after hip joint arthroplasty operations on wound healing was investigated. The wounds were drained with the Redon high-vacuum system or the newly developed, permanently closed drainage system with maximum obtainable low pressure of 80% vacuum and 50% vacuum. Here the maximum obtainable vacuum builds up slowly in relation to the accumulated amount of wound fluids. The loss of low pressure in Redon systems differs between the drains. In the intra-articular drains the mixture of air and blood results in a linear decrease and follows not a hyperbola like in subcutaneous drains. Because of the high suction at the beginning of the Redon drainage necrotic muscle cells adhere to the outside of the drain openings and clogs them up mechanically. The stronger the suction effect on the tissue, the more fatty live cells and small vessels enter the lumen of the drain in the Redon system and 80% vacuum. This mechanisms result in bleeding from the drain canal after removal of the drain and "secondary" haematomas. In the absolutely continuously closed system with maximum obtainable low pressure of 50% vacuum increased suction, lowered bleeding after removal of the drain and best healing results were observed. The 9.8% Cfu occurrence on Redon drains after removal found in the study is within the lower average figures given in literature while the 0.9% figure with both closed systems was never reached before.
Topics: Equipment Failure; Hematoma; Hip Prosthesis; Humans; Postoperative Complications; Suction; Surgical Wound Infection
PubMed: 2183501
DOI: No ID Found -
The Surgeon : Journal of the Royal... Jun 2022The role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The role of closed suction drainage during elective total joint arthroplasty is still unclear. The present study compared the use of closed suction drains to no drainage for elective total knee arthroplasty (TKA) and in total hip arthroplasty (THA) through a meta-analysis of randomized clinical trials (RCTs).
METHODS
Following the PRISMA guidelines, a meta-analysis of randomized controlled trials identified in December 2021. All randomized clinical trials comparing the use of closed suction drains to no drainage for elective THA or TKA were considered.
RESULTS
Twenty-five RCTs were included in the final analysis. 49% (1722 of 3505) of patients received no-drainage, and 51% (1783 of 3505) received closed suction drainage. There was no evidence of a statistically significant evidence between the two groups in occurrence of postoperative infections (P = 0.4), mean total postoperative hemoglobin (P = 0.2) or length of hospital stay (P = 0.1). The no-drainage group showed a lower rate of blood transfusion (P < 0.0001).
CONCLUSION
There is no evidence to support the routine use of closed suction drainage in THA or TKA patients.
LEVEL OF EVIDENCE
Level I, meta-analysis of randomized clinical trials.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Drainage; Humans; Lower Extremity; Suction
PubMed: 33863671
DOI: 10.1016/j.surge.2021.02.014 -
Journal of Cranio-maxillo-facial... Sep 2014There have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in...
PURPOSE
There have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI.
PATIENTS AND METHODS
This study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated.
RESULTS
CSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2-7 drains) over the course of 4-37 days (mean 14.6 days). The total amount of drained pus was 8-1344 cc (mean: 406 cc) and the daily amount was 1-61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9-83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001).
CONCLUSION
Accurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cause of Death; Chronic Disease; Female; Focal Infection, Dental; Follow-Up Studies; Heart Arrest; Hospitalization; Humans; Hypoxia; Length of Stay; Male; Mandibular Diseases; Mediastinal Diseases; Middle Aged; Neck; Pharyngeal Diseases; Pulmonary Edema; Retrospective Studies; Suction; Suppuration; Tracheostomy; Young Adult
PubMed: 24360753
DOI: 10.1016/j.jcms.2013.11.006