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Drain options after vertebral body tethering

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Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

Since the introduction of vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS), a variety of post-operative chest drainage systems have been utilized. Most surgeons use formal chest tubes with a Pleur-evac, while others use smaller bulb suction drains (e.g., Blake drain). In addition, some centers utilize pleural closure. This multicenter study evaluates whether drain type or pleural closure impact perioperative and 90 day complication rates.

Methods

A retrospective review was conducted from three institutions with established VBT programs. All preoperative, perioperative and 90 day postoperative data were analyzed to determine differences in outcomes between three cohorts: standard chest tube (SCT), standard chest tube with pleural closure (SCTPC) and 10 French Bulb drain (BD).

Results

104 patients were identified for the study. 57 SCT, 25 SCTPC and 22 BD. All data are listed in order: SCT, SCTPC, BD. Length of stay (3.7, 4.3, 3.0 days) was less in the BD group (p = 0.009); post-operative drainage (460, 761, 485 cc) was less in the SCT and BD groups (p < 0.001); intra-operative estimated blood loss (EBL) 146, 382, 64 cc was less in the BD group (p < 0.001). No significant difference in number of days (3.2, 3.2, and 2.8 days) drainage was in place, groups (p = 0.311). Complication profile was similar with 2 chest tube reinsertions in the SCT and one hemothorax that resolved spontaneously in BD group.

Conclusions

In this series of 104 patients, SCT, SCTPC and BD all had a similar safety profile. All three methods were safe and effective in managing post-operative chest drainage after thoracic VBT. In the series, BD group had significantly shorter LOS than both groups that used chest tubes.

Level of evidence

Level III, Retrospective cohort study.

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Acknowledgements

The authors would like to acknowledge the following members of the Harms Study Group: Mark Able MD, John Asghar MD, Keith Bachmann MD, Randy Betz MD, Aaorn Buckland MD, Patrick Cahill MD, David Clements MD, Mark Erickson MD, Nicholas Fletcher MD, Jack Flynn MD, Peter Gabos MD, Sumeet Garg MD, Stephen George MD, Michael Glotzbecker MD, Munish Gupta MD, Juergen Harms MD, Daniel Hedequist MD, Steven Hwang MD, Amit Jain MD, Michael Kelly MD, Hubert Labelle MD, Larry Lenke MD, Baron Lonner MD, Jean Mac-Thiong MD, Josh Pahys MD, Stefan Parent MD, Ben Roye MD, Suken Shah MD, Harry Shufflebarger MD, Paul Sponseller MD, Peter Sturm MD, Daniel Sucato MD, Salil Upasani MD, Michael Vitale MD, Burt Yaszay MD.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA

    Lawrence Haber, Hunter Starring, Bhumit Desai & Whitney Fant

  2. University of Queensland-Ochsner Clinical School, New Orleans, LA, USA

    Nicholas Newcomb

  3. Department of Pediatric Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    Jessica Roybal

  4. Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    A. Noelle Larson & Todd Milbrandt

  5. Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA

    Melanie Boeyer & Dan Hoernschemeyer

  6. Setting Scoliosis Straight, El Cajon, CA, USA

    Michelle Marks

  7. Division Orthopedics and Scoliosis, Rady Children’s Hospital, San Diego, CA, USA

    Peter Newton

  8. Department of Pediatric Orthopedic Surgery, Shriners Children’s Philadelphia, Philadelphia, PA, USA

    Amer Samdani

  9. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Firoz Miyanji

Authors
  1. Lawrence Haber
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  2. Hunter Starring
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  3. Nicholas Newcomb
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  4. A. Noelle Larson
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  5. Bhumit Desai
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  6. Jessica Roybal
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  7. Whitney Fant
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  8. Todd Milbrandt
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  9. Melanie Boeyer
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  10. Michelle Marks
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  11. Peter Newton
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  12. Amer Samdani
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  14. Dan Hoernschemeyer
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Consortia

Harms Study Group Investigators

  • Mark Able
  • , John Asghar
  • , Keith Bachmann
  • , Randy Betz
  • , Aaorn Buckland MD
  • , Patrick Cahill
  • , David Clements
  • , Mark Erickson
  • , Nicholas Fletcher
  • , Jack Flynn
  • , Peter Gabos
  • , Sumeet Garg
  • , Stephen George
  • , Michael Glotzbecker
  • , Munish Gupta
  • , Juergen Harms
  • , Daniel Hedequist
  • , Steven Hwang
  • , Amit Jain
  • , Michael Kelly
  • , Hubert Labelle
  • , Larry Lenke
  • , Baron Lonner
  • , Jean Mac-Thiong
  • , Josh Pahys
  • , Stefan Parent
  • , Ben Roye
  • , Suken Shah
  • , Harry Shufflebarger
  • , Paul Sponseller
  • , Peter Sturm
  • , Daniel Sucato
  • , Salil Upasani
  • , Michael Vitale
  •  & Burt Yaszay

Contributions

LH: conception/data collection and interpretation, writing and revision, final approved, agreed. HS: conception/data collection and interpretation, writing and revision, final approved, agreed. NN: data collection/analysis, writing and revision, final approved, agreed. ANL: conception/data collection and analysis, revision, final approved, agreed. BD: data collection/analysis, writing, final approved, agreed. JR: data interpretation, writing and revision, final approved, agreed. WF: data collection/interpretation, writing, final approved, agreed. TM: conception, writing and revision, final approved, agreed. MB: data interpretation, writing and revision, final approved, agreed. MM: data interpretation, revision, final approved, agreed. PN: data interpretation, revision, final approved, agreed. AS: data interpretation, revision, final approved, agreed. FM: data interpretation, revision, final approved, agreed. DH: data interpretation, revision, final approved, agreed. Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. Drafted the work or revised it critically for important intellectual content. Approved the version to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Hunter Starring.

Ethics declarations

Conflict of interest

Peter Newton MD: during the conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the submitted work: grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, personal fees from Cubist, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from Stryker/K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, personal fees from MiRus, personal fees from Globus Medical, personal fees from Pacira, from Scoliosis Research Society. In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent Screw placement guide (7981117) licensed to DePuy Spine, Inc., a patent Compressor for use in minimally invasive surgery (7189244) licensed to DePuy Spine, Inc., and a patent Posterior spinal fixation pending to K2M. Amer Samdani MD: during the conduct of the study: grants from Setting Scoliosis Straight Foundation. Outside the submitted work: personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet. Firoz Miyanji MD: during the Conduct of the Study: grants from Setting Scoliosis Straight Foundation. Outside the Submitted Work: personal fees from Deupy Synthes Spine, personal fees from Stryker Spine, personal fees from Zimmer Biomet. This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, Stryker Spine, Medtronic, NuVasive, Zimmer Biomet and the Food and Drug Administration.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Ochsner Clinic Foundation, Mayo Clinic, and University of Missouri-Columbia approved this study.

Informed consent

No informed consent was needed as this was a retrospective chart review, and no identifying information was used.

Human and animal rights

This article was a retrospective chart review and, thus, did not infringe on rights of humans or animals.

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Haber, L., Starring, H., Newcomb, N. et al. Drain options after vertebral body tethering. Spine Deform 11, 367–372 (2023). https://doi.org/10.1007/s43390-022-00595-5

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  • DOI: https://doi.org/10.1007/s43390-022-00595-5

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