Abstract
Purpose
The use of closed-suction drainage systems to evacuate haematomas after surgical procedures is still common practice in many orthopaedic departments. However, no evidence to support the routine use of closed-suction drains in orthopaedic surgery exists. Post-operative handling and removal of the drain is particularly complicated in children. We hypothesised that the use of surgical drains in major hip procedures in children does not reduce the complication rate.
Methods
The records of 63 children undergoing 97 major hip procedures managed with closed-suction drains (centre A), and 75 children undergoing 130 major hip procedures without application of wound drains (centre B) were retrospectively reviewed in this dual-centre study. Demographic data, pre-existing conditions, surgical indications and procedures, duration of hospitalisation and complication rates were analysed.
Results
Children (mean age, 8.3 ± 4 years) in both groups presented similar demographics, medical histories, surgical indications and procedures. No intra-operative complications occurred in either group. In the undrained group a significant shorter hospitalisation time was observed. Overall, there were 31 complications (31.9 %) in the drained group and 26 complications (20 %) in undrained group (p = 0.05). Applying the Clavien-Dindo grading system, both groups had mainly minor grade I and grade II complications. No differences regarding the rate of wound-related complications were observed between the two groups.
Conclusions
The use of wound drains in our study cohorts has been shown to have no positive impact on complications rates after corrective osteotomies around the hip joint in children. In the light of our results and of the poor evidence of drainage use in adults, we do not recommend the routine use of drains in children undergoing orthopaedic hip procedures.
Similar content being viewed by others
References
Acus RW 3rd, Clark JM, Gradisar IA Jr, Kovacik MW (1992) The use of postoperative suction drainage in total hip arthroplasty. Orthopedics 15:1325–1328
Liang J, Qiu G, Chua S, Shen J (2013) Comparison between subcutaneous closed-suction drainage and conventional closed-suction drainage in adolescents idiopathic scoliosis patients undergoing posterior instrumented spinal fusion: a randomized control trial. J Spinal Disord Tech 26:256–259
Drinkwater CJ, Neil MJ (1995) Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 10:185–189
Willett KM, Simmons CD, Bentley G (1988) The effect of suction drains after total hip replacement. J Bone Joint Surg (Br) 70:607–610
Waugh TR, Stinchfield FE (1961) Suction drainage of orthopaedic wounds. J Bone Joint Surg Am 43(7):939–1021
Parker MJ, Livingstone V, Clifton R, McKee A (2007) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev: CD001825
Bittersohl B, Hosalkar HS, Wenger DR (2012) Surgical treatment of hip dysplasia in children and adolescents. Orthop Clin North Am 43:301–315
Kosuge D, Yamada N, Azegami S, Achan P, Ramachandran M (2013) Management of developmental dysplasia of the hip in young adults: current concepts. Bone Joint J 95-B:732–737
Leunig M, Ganz R (2014) The evolution and concepts of joint-preserving surgery of the hip. Bone Joint J 96-B:5–18
Panigrahi R, Sahu B, Mahapatra AK, Palo N, Priyadarshi A, Biswal MR (2015) Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario. Int Orthop 39(6):1121–1127. doi:10.1007/s00264-015-2677-y
Joeris A, Audigé L, Ziebarth K, Slongo T (2012) The locking compression paediatric hip plate: technical guide and critical analysis. Int Orthop 36(11):2299–2306. doi:10.1007/s00264-012-1643-1
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Ho C, Skaggs DL, Weiss JM, Tolo VT (2007) Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine (Phila Pa 1976) 32:2739–2744
Blank J, Flynn JM, Bronson W, Ellman P, Pill SG et al (2003) The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis. J Spinal Disord Tech 16:508–512
Diab M, Smucny M, Dormans JP, Erickson MA, Ibrahim K et al (2012) Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 37:966–973
Ho C, Sucato DJ, Richards BS (2007) Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 32:2272–2277
Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J et al (2012) Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 470:2220–2226
Clifton R, Haleem S, McKee A, Parker MJ (2008) Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop 32:723–727
Cobb JP (1990) Why use drains? J Bone Joint Surg (Br) 72:993–995
Duranthon LD, Grimberg J, Vandenbussche E, Mondoloni B, Augereau P (2000) Effectiveness of postoperative drainage after bipolar sealed endoprosthetic arthroplasty for femur neck fracture. Results of a prospective randomized study of 86 cases. Rev Chir Orthop Reparatrice Appar Mot 86:370–372
Nicolajsen K, Jorgensen PS, Torholm C (1996) Brodie abscess. Primarily misinterpreted as traumatic lesion. Ugeskr Laeger 158:171–172
Tjeenk RM, Peeters MP, van den Ende E, Kastelein GW, Breslau PJ (2005) Wound drainage versus non-drainage for proximal femoral fractures. A prospective randomised study. Injury 36:100–104
Acknowledgments
The authors declare that there are no potential conflicts of interest, real or perceived, in: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; (4) the decision to submit the paper for publication. No funding was received for this work.
Author information
Authors and Affiliations
Corresponding author
Additional information
Claudia Druschel and Katherina Heck contributed equally to this work
Rights and permissions
About this article
Cite this article
Druschel, C., Heck, K., Pennekamp, P.H. et al. Avoiding drainage after major hip surgery in children is a viable option: results from a retrospective comparative study. International Orthopaedics (SICOT) 40, 129–133 (2016). https://doi.org/10.1007/s00264-015-2918-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-015-2918-0