Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial
To explore the role of closed suction drain in multi-level posterior spinal surgery.
We performed prospective, open-label, randomised control, superiority trial with parallel design and 1:1 allocation. A total of 161 patients undergoing posterior spinal surgery involving more than one motion segment at a dedicated spine surgery department were randomly allocated into “drain” or “no-drain” groups, based on which surgical drain was employed at the end of surgery. After excluding six cases with intraoperative dural tear, the data of 80 patients in “drain” and 75 patients in “no-drain” group were analysed. Primary outcome was total perioperative blood loss (sum of intraoperative blood loss, volume of drain if present and volume aspirated if patient developed collection in relation to surgical wound). The secondary outcomes were transfusion requirements, wound healing and complications.
Both groups were comparable with respect to baseline characteristics. Total perioperative blood loss was significantly higher in “drain” group (716 ± 312.97 ml vs 377.9 ± 295.72 ml, p < 0.0001). Number and volume of post-operative aspirations were significantly higher in “no-drain” group whereas transfusion requirements were significantly higher in “drain” group. Except for one case of superficial wound inflammation in either group, there were no complications. Subgroup analysis revealed that the results were applicable for surgeries involving “two/three” levels and “more than three” levels.
The practice of not using closed surgical drains after multi-level posterior spinal surgery reduces post-operative blood loss and transfusion requirements. But this comes with the disadvantage of increased wound soakage and need for post-operative wound aspirations. The risks of benefits of “drain” and “no drain” must be carefully weighed and an informed choice be taken.
KeywordsSpine surgery Perioperative blood loss Closed suction drain
We thank Dr. Phaniraj Vastrad, MPH, Jr. Project Manager, SMACK Consultancy, Stockholm, Sweden, and Mrs. Bhavani Manivannan, MSc, Asst Manager, Chondrocyte Cell Culture Laboratory, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, India, for their assistance in statistical analysis of the data.
Compliance with ethical standards
Conflict of interest
All authors certify that they have no conflict of interests.
- 4.Sangrasi AK, Leghari AA, Memon A, Talpur AK, Qureshi GA, Memon JM (2008) Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan. Int Wound J 5(1):74–78. https://doi.org/10.1111/j.1742-481X.2007.00365.x CrossRefGoogle Scholar
- 6.Soleto L, Pirard M, Boelaert M, Peredo R, Vargas R, Gianella A, Van der Stuyft P (2003) Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general ward in Santa Cruz, Bolivia. Infect Control Hosp Epidemiol 24(1):26–30CrossRefGoogle Scholar
- 8.Parker M, Livingstone V, Clifton R, McKee A (2007) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 18(3):CD001825Google Scholar
- 17.Power calculator for continuous outcome equivalence trial. https://sealedenvelope.com/power/continuous-superiority Accessed 1 Oct 2017
- 20.Scuderi GJ, Brusovanik GV, Fitzhenry LN, Vaccaro AR (2005) Is wound drainage necessary after lumbar spinal fusion surgery? Med Sci Monit 11(2):CR64–CR66Google Scholar
- 21.Rao SB, Vasquez G, Harrop J, Maltenfort M, Stein N, Kaliyadan G, Klibert F, Epstein R, Sharan A, Vaccaro A, Flomenberg P (2011) Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 53(7):686–692. https://doi.org/10.1093/cid/cir506 CrossRefGoogle Scholar