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PloS One 2021Increased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD)...
PURPOSE
Increased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD) on postoperative blood loss and transfusion requirement in cementless SBTHA.
METHODS
A retrospective cohort study was conducted with a consecutive series of cementless SBTHAs performed by a single surgeon between January 2014 and March 2017. The surgeon routinely used CSD until May 2015 and refrained from CSD in all primary THAs thereafter. This study included SBTHAs with intravenous administration of tranexamic acid (TXA). Postoperative hemoglobin drop, blood loss, transfusion rate, pain scores, complication rates, and implant survivorships were compared between the groups of SBTHA with and without CSD. The minimum follow-up duration was 1 year.
RESULTS
Among the 110 patients (220 hips), 46 (92 hips) and 64 (128 hips) underwent SBTHA with and without CSD, respectively. Maximum hemoglobin drop (mean, 4.8 vs. 3.9 g/dL; P = 0.001), calculated blood loss (mean, 1530 vs. 1190 mL; P<0.001), transfusion rate (45.7% vs. 21.9%; P = 0.008), and length of hospital stay (mean, 6.6 vs. 5.8 days; P = 0.004) were significantly lower in patients without CSD. There were no significant differences in postoperative pain scales and wound complication rates. The mean Harris Hip scores at final follow-up (92.5 vs. 92.1; P = 0.775) and implant survivorships with an end-point of any revision at 4 years (98.9% vs. 98.4%; log-rank, P = 0.766) were similar between groups.
CONCLUSIONS
Disusing CSD significantly reduced postoperative blood loss and transfusion requirement without increasing postoperative pain and surgical wound complications in cementless SBTHA with concurrent administration of intravenous TXA.
Topics: Adult; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Transfusion; Female; Humans; Middle Aged; Postoperative Hemorrhage; Retrospective Studies; Suction; Tranexamic Acid
PubMed: 33657165
DOI: 10.1371/journal.pone.0247845 -
The Journal of Arthroplasty Dec 2011From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the... (Comparative Study)
Comparative Study Meta-Analysis
From individual randomized studies, it is not clear whether a closed suction drainage should be used after total knee arthroplasty. Our meta-analysis compares the clinical outcomes of closed suction drainage with nondrainage after total knee arthroplasty in randomized controlled trials reported between January 1966 and May 2010. Fifteen eligible trials involving 1361 knee incisions (686 knees with closed suction drainage and 675 knees without drainage) satisfied the inclusion criteria for our meta-analysis. The result of the meta-analysis indicates that closed suction drainage reduces the incidence of soft tissue ecchymosis and requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference between drainage and nondrainage was observed in the incidence of infection, deep venous thrombosis, or postoperative range of motion.
Topics: Aged; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Ecchymosis; Female; Humans; Incidence; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Randomized Controlled Trials as Topic; Range of Motion, Articular; Retrospective Studies; Suction; Surgical Wound Infection; Treatment Outcome; Venous Thrombosis
PubMed: 21371856
DOI: 10.1016/j.arth.2011.02.005 -
Journal of Orthopaedic Surgery and... May 2019In an enhanced recovery after surgery program, not placing a closed suction drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable.... (Clinical Trial)
Clinical Trial
Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study.
BACKGROUND
In an enhanced recovery after surgery program, not placing a closed suction drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable. However, the influence of drain use on transfusion rate and postoperative length of stay (PLOS) in TJA remains controversial. Therefore, we aimed to compare drain use with no drain in routine primary TJA to determine the differences in transfusion rate and PLOS.
METHODS
We analyzed the data from 12,992 patients undergoing primary unilateral TJA: 6325 total knee arthroplasties (TKA) and 6667 total hip arthroplasties (THA). Patients were divided into two groups according to whether they received a drain postoperatively following TKA and THA. We extracted information for transfusion and PLOS from patients' electronic health records and analyzed the data by logistic and linear regression analyses.
RESULTS
The transfusion rate and PLOS were 15.07% and 7.75 ± 3.61 days, respectively, in the drain group and 6.72% and 6.54 ± 3.32 days, respectively, in the no-drain group following TKA. The transfusion rate and PLOS were 20.53% and 7.00 ± 3.35 days, respectively, in the drain group and 13.57% and 6.07 ± 3.06 days, respectively, in the no-drain group following THA. After adjusting for the following variables: age, gender, body mass index, orthopedic diagnoses, hypertension, type 2 diabetes, coronary heart disease, chronic obstructive pulmonary disease, preoperative hemoglobin, albumin, analgesic use, anesthesia, American Society of Anesthesiologists class, tranexamic acid use, intraoperative bleeding, operative time, and tourniquet use (for TKA), drain use correlated significantly with a higher transfusion rate (risk ratio = 2.812, 95% confidence interval (CI) 2.224-3.554, P < 0.001 for TKA and risk ratio = 1.872, 95% CI 1.588-2.207, P < 0.001 for THA) and a longer PLOS (partial regression coefficient (B) = 1.099, 95% CI 0.879-1.318, P < 0.001, standard regression coefficient (B') = 0.139 for TKA; B = 0.973, 95% CI 0.695-1.051, P < 0.001, and B' = 0.115 for THA). Two groups showed no significant difference in wound complications.
CONCLUSIONS
Our findings indicated that drain use was associated with a higher transfusion rate and a longer PLOS in patients undergoing routine primary TJA. The routine use of postoperative drainage is not recommended in primary unilateral TJA.
Topics: Aged; Arthroplasty, Replacement, Knee; Blood Transfusion; Cohort Studies; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Care; Postoperative Complications; Prospective Studies; Retrospective Studies; Suction
PubMed: 31142376
DOI: 10.1186/s13018-019-1211-0 -
Annals of Plastic Surgery Apr 2018Placement of suction drainage in submuscular pockets is routinely performed in breast reconstruction. Days of drain permanence (DDP) are associated with hospital stay...
BACKGROUND
Placement of suction drainage in submuscular pockets is routinely performed in breast reconstruction. Days of drain permanence (DDP) are associated with hospital stay and related health care costs. The aims of this study are to retrospectively compare data related to DDP and total drainage volume between high and low vacuum suction drainage groups and to identify correlations with patient or surgery-related factors.
METHODS
We retrospectively analyzed data of 100 patients undergoing immediate or delayed breast reconstruction with expanders and implants. We considered 2 groups depending on suction pressure applied by 2 different surgical teams: group A (number, 50 patients) with high vacuum suction and group B (number, 50 patients) with low vacuum suction.
RESULTS
Days of drain permanence was not significantly different between group A and group B (P = 0.451). The same was found for total drainage volume (P = 0.183). The distribution of DDP was statistically different only between patients with or without intraoperative bleeding in group A (P = 0.005) and smoking or nonsmoking patients in group A (P = 0.045). Statistical significance was kept in multivariate regression.
CONCLUSIONS
There is no significant difference in DDP and total drainage volume using low or high vacuum suction drainage in breast reconstruction. The only factors affecting drainage permanence were intraoperative filling of expander, smoking, and intraoperative bleeding. Therefore, we can reduce the DDP, avoiding overfilling of expander and using of high vacuum suction in nonsmoking patients and in patients with significant intraoperative bleeding.
Topics: Adult; Breast Implants; Drainage; Female; Humans; Mammaplasty; Middle Aged; Retrospective Studies; Seroma; Suction; Tissue Expansion Devices; Treatment Outcome; Vacuum
PubMed: 29095190
DOI: 10.1097/SAP.0000000000001246 -
The Journal of Urology Jan 2004Prospective studies in the general surgery literature have shown fewer wound related complications with closed suction drainage than with open passive drainage....
PURPOSE
Prospective studies in the general surgery literature have shown fewer wound related complications with closed suction drainage than with open passive drainage. Nevertheless, some urologists avoid closed suction drains after partial nephrectomy mainly because of a theoretical increased risk of a prolonged urinary leak or delayed hemorrhage.
MATERIALS AND METHODS
We reviewed the records of 184 patients who underwent 197 consecutive partial nephrectomies at our institution. Closed suction or open passive (Penrose) drainage was used based on surgeon preference. Drain type was compared with duration of use and the incidence of relevant complications.
RESULTS
A Penrose drain was used in 37.6% (74 of 197) of partial nephrectomies and a closed suction drain was used in 62.4% (123). Clinical characteristics were equivalent between both groups, including age, body mass index, tumor size (mean 3.1 cm), number of renal tumors excised, estimated blood loss and operative time. There was no statistically significant difference in the duration of drainage between the Penrose group (mean 7.1 days) and the closed suction group (7.8 days). While we found variation in the incidence of relevant complications by drain type, none of these differences was statistically significant. Complications included prolonged urinary drainage in 7.6% of cases (8.9% closed suction, 5.4% Penrose), wound infection or perinephric abscess in 3.6% (2.4% closed suction, 5.4% Penrose) and delayed hemorrhage in 1.5% (2.4% closed suction, 0 Penrose).
CONCLUSIONS
No statistically significant differences in postoperative morbidity were observed between the use of closed suction or Penrose retroperitoneal drains after partial nephrectomy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Drainage; Humans; Middle Aged; Nephrectomy; Postoperative Care; Postoperative Complications; Retrospective Studies; Suction
PubMed: 14665885
DOI: 10.1097/01.ju.0000099940.02698.38 -
Thorax Jan 1982Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with underwater seal were divided randomly into two groups, one receiving suction drainage (up to 20 cm H2O pressure) and the other no suction. The success rate was 57% for the former and 50% for the latter. The suction group spent an average of five days in hospital, whereas the non-suction group averaged four days. Suction drainage therefore did not have any advantage. To determine how soon the catheter could be removed without complication, patients were also divided randomly into two subgroups--one had the catheter removed, without previous clamping, as soon as the lung was expanded; the other had the catheters left in situ for a further three days. The success rate was 52% for the former, and 53% for the latter. But most of the failure in the early removal group was caused by re-collapse of the lung rather than persistent air leakage; hence removal of the catheter too early was not recommended.
Topics: Adolescent; Adult; Aged; Catheterization; Drainage; Female; Humans; Male; Middle Aged; Pneumothorax; Prospective Studies; Suction; Time Factors
PubMed: 7071793
DOI: 10.1136/thx.37.1.46 -
Veterinary Surgery : VS Oct 2014To determine survival rate in dogs with septic peritonitis of confirmed gastrointestinal origin treated with closed suction drainage.
OBJECTIVE
To determine survival rate in dogs with septic peritonitis of confirmed gastrointestinal origin treated with closed suction drainage.
STUDY DESIGN
Retrospective case series.
ANIMALS
Dogs (n = 20) with septic peritonitis.
METHODS
Medical records (2007-2010) of dogs with septic peritonitis of confirmed gastrointestinal origin treated by closed suction drainage were reviewed. Information on signalment, clinicopathologic abnormalities, underlying cause, surgical procedure performed, postoperative management, complications, and outcome was obtained.
RESULTS
Dehiscence of a previous anastomosis was the most common source of contamination (80%). Drains remained in place, collecting fluid produced within the abdomen, for a median of 6 days (range, 2-11 days). Eighteen dogs received nutritional support, and 14 received plasma transfusions. Seventeen dogs (85%) survived to discharge.
CONCLUSIONS
Closed suction drainage together with resolution of the underlying cause of peritonitis and appropriate postoperative management is an effective technique for treatment of septic peritonitis of confirmed gastrointestinal origin in dogs.
Topics: Animals; Dog Diseases; Dogs; Drainage; Female; Male; Peritonitis; Postoperative Complications; Retrospective Studies; Sepsis; Suction; Treatment Outcome
PubMed: 25132380
DOI: 10.1111/j.1532-950X.2014.12258.x -
Journal of Nippon Medical School =... 2018Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of...
Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. We then performed subcuticular suturing with 4-0 monofilament absorbable sutures. The median age of our patient population (34 men and 15 women) was 68 (range, 35-84) years. Six patients had an end stoma and 43 had a loop stoma. The wound category was 'contaminated' in 18 patients, while an incisional SSI was observed in one patient (2.0%). No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Retrospective Studies; Suction; Surgical Stomas; Surgical Wound; Surgical Wound Infection; Suture Techniques; Sutures
PubMed: 30135346
DOI: 10.1272/jnms.JNMS.2018_85-27 -
The Spine Journal : Official Journal of... Sep 2018Patients with infective spondylodiscitis who failed conservative treatment are generally indicated for open surgery. However, some patients are poor candidates for...
BACKGROUND CONTEXT
Patients with infective spondylodiscitis who failed conservative treatment are generally indicated for open surgery. However, some patients are poor candidates for standard surgery, hence the need to evaluate less invasive approaches. Good outcomes were previously reported for percutaneous suction aspiration and drainage (PSAD) in the treatment of infective spondylodiscitis resistant to conservative therapy. We recently extended the surgical approach of PSAD to allow drainage of paravertebral or epidural abscesses in patients with progressive infective spondylodiscitis.
PURPOSE
To evaluate the clinical outcomes of PSAD for infective spondylodiscitis with paravertebral or epidural abscess.
DESIGN
Retrospective case series.
PATIENT SAMPLE
Patients with infective spondylodiscitis and associated epidural or paravertebral abscess treated using PSAD at our institution, between 1998 and 2014.
OUTCOME MEASURES
Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and imaging data obtained via plain radiography, computed tomography, and magnetic resonance imaging were analyzed. Serum measurements were taken preoperatively and at several time points postoperatively. Clinical outcomes were evaluated using the modified MacNab criteria for overall functional mobility.
METHODS
Data were obtained from the patients' case notes, radiological images, and medical records. Student t test was used to assess the relevance of changes in serum levels of CRP and ESR at each evaluated time point, as well as the change in sagittal Cobb angle between the preoperative state and the state at final follow-up.
RESULTS
Fifty-two patients (31 men and 21 women; average age, 70.6 years) were included in our analysis. The median (range) CRP levels and ESR values at the time of diagnosis were 6.86 (0.04-20.15) mg/dL and 78.8 (26-120) mm/h, respectively. At 1 year postoperatively, these values had decreased to 0.18 (0.0-1.2) mg/dL and 13.8 (4-28) mm/h for CRP and ESR, respectively. At final follow-up, bone union was observed in 80.8% (42 of 52) of patients, with instability identified in five patients. Regarding functional mobility, excellent outcomes were obtained in 26.9% (14 of 52) of patients, whereas good, fair, and poor outcomes were noted in 42.3% (22 of 52), 3.9% (2 of 52), and 26.9% (14 of 52) of patients, respectively. Overall, treatment was considered effective in 69.2% (36 of 52) of patients.
CONCLUSIONS
Percutaneous suction aspiration and drainage can serve as an effective alternative to open surgery for the treatment of patients with progressive infective spondylodiscitis and associated paravertebral or epidural abscess.
Topics: Adult; Aged; Discitis; Drainage; Epidural Abscess; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Suction; Tomography, X-Ray Computed
PubMed: 29496623
DOI: 10.1016/j.spinee.2018.02.020 -
Journal of Spinal Disorders & Techniques Jul 2013Prospective, randomized controlled clinical study. (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparison between subcutaneous closed-suction drainage and conventional closed-suction drainage in adolescent idiopathic scoliosis patients undergoing posterior instrumented spinal fusion: a randomized control trial.
STUDY DESIGN
Prospective, randomized controlled clinical study.
OBJECTIVE
To evaluate the efficacy of subcutaneous closed-suction drainage in reducing blood loss as compared with conventional closed-suction drainage in adolescent idiopathic scoliosis cases undergoing posterior instrumented spinal fusion.
BACKGROUND
Subcutaneous closed-suction drainage is reported to be a reasonable alternative to intra-articular indwelling closed-suction drainage and to that of no usage of any drainage system in knee arthroplasty. However, little is reported about the use of subcutaneous closed-suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion.
METHODS
A total of 105 adolescent idiopathic scoliosis patients undergoing posterior instrumented spinal fusion were randomized into 2 groups of either a subcutaneous drainage or a conventional closed-wound suction drainage system. These 2 groups were compared for demographic distribution, blood loss (hemoglobin/hematocrit changes, transfusion requirements), and incidence of wound problems (requirements for dressing reinforcement, oozing, subcutaneous hematoma, ecchymosis, infection).
RESULTS
Mean drainage volume was less (P=0.000) in the subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (42 vs. 631 mL). The groups were statistically similar in terms of hemoglobin and hematocrit values obtained on the third postoperative day (10.60 vs. 9.52 g/dL, P=0.110; 30.85% vs. 27.82%, P=0.226), on discharge (10.90 vs. 9.75 g/dL, P=0.114; 31.10% vs. 28.13%, P=0.147), transfusion requirements (31.2% vs. 45.6%, P=0.133), and incidence of wound problems. However, the core temperature values were higher in subcutaneous closed-wound suction drainage group compared with the conventional closed-wound suction drainage group (P=0.001), and the duration of fever was longer in the former compared with the latter (P=0.008).
CONCLUSIONS
The data suggest that subcutaneous closed-suction drainage offers a reasonable alternative to closed-wound suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion.
Topics: Adolescent; Child; Female; Humans; Male; Prospective Studies; Scoliosis; Spinal Fusion; Subcutaneous Tissue; Suction
PubMed: 22134736
DOI: 10.1097/BSD.0b013e3182400897