50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery
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While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding.
A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003–2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs.
Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons.
This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding.
Level of Evidence IV
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KeywordsClosed suction drains (CSDs) Breast surgery Prediction of postoperative bleeding Diagnostic validity
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Institutional research ethics committee approval (Ref. 18-955-104) was obtained prior to the initiation of this study.
Informed patient consent was obtained.
- 2.Phillips BT, Wang ED, Mirrer J, Lanier ST, Khan SU, Dagum AB, Bui DT (2011) Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg 66:460–465CrossRefGoogle Scholar
- 4.Inwang R, Hamed H, Chaudary MA, Fentiman IS (1991) A controlled trial of short-term versus standard axillary drainage after axillary clearance and iridium implant treatment of early breast cancer. Ann R Coll Surg Engl 73:326–328Google Scholar
- 7.Khan SM, Smeulders MJ, Van der Horst CM (2015) Wound drainage after plastic and reconstructive surgery of the breast. The Cochrane database of systematic reviews: CD007258Google Scholar
- 20.Hajian-Tilaki K (2013) Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med 4:627–635Google Scholar
- 21.Simundic AM (2009) Measures of diagnostic accuracy: basic definitions. EJIFCC 19:203–211Google Scholar