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Impact of closed suction drainage after surgical fixation of acetabular fractures

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The purpose of the present study was to evaluate the prevalence of closed suction drainage after a Kocher–Langenbeck (K–L) approach for surgical fixation of acetabular fractures and to determine the impact of closed suction drainage on patient outcomes.

Methods

This retrospective study reports on 171 consecutive patients that presented to a single level I trauma center for surgical fixation of an acetabular fracture. Medical records were reviewed to evaluate the use of closed suction drains. The primary outcomes measures were rate of packed red blood cell (PRBC) transfusion and length of hospital stay (LOS). Secondary outcome measures were 30-day post-operative wound complication and 1-year deep infection rates.

Results

Of the 171 patients included in this study, 140 (82%) patients were treated with drains. There was a significant association between the use of closed suction drainage and post-operative blood transfusion rate (p = 0.002). Thirty-five patients (25%) treated with drains required a post-operative blood transfusion compared to 0% in the no drain cohort. Regarding the total number of drains used, for every additional closed suction drain that was placed beyond a single drain, the odds of receiving a blood transfusion doubled (p = 0.002). Use of closed suction drainage was associated with a significantly longer LOS (p = 0.015), and no difference in wound complication or deep infection rates.

Conclusion

The use of closed suction drains for treatment of acetabular fractures using a K–L approach is associated with increased rates of blood transfusion and increased length of hospital stay, with no impact on surgical site infection rates. The results of this study suggest against routine drain usage in acetabular surgery.

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References

  1. Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res. 151:81–106

    Google Scholar 

  2. Judet R, Judet J, Letoumel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. J Bone Jt Surg 46A:1615–1646

    Article  Google Scholar 

  3. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Jt Surg Am 78:1632–1645

    Article  CAS  Google Scholar 

  4. Moed BR, Carr SE, Watson JT (2000) Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res 377:57–67

    Article  Google Scholar 

  5. Moed BR, WillsonCarr SE, Watson JT (2002) Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Jt Surg Am 84-A:752–758

    Article  Google Scholar 

  6. Cutrera NJ, Pinkas D, Toro JB (2015) Surgical approaches to the acetabulum and modifications in technique. J Am Acad Orthop Surg 23(10):592–603

    Article  PubMed  Google Scholar 

  7. Matta JM, Merritt PO (1988) Displaced acetabular fractures. Clin Orthop Relat Res 230:83–97

    Google Scholar 

  8. Magu NK, Rohilla R, Arora S et al (2011) Modified Kocher–Langenbeck approach for the stabilization of posterior wall fractures of the acetabulum. J Orthop Trauma 25:243–249

    Article  PubMed  Google Scholar 

  9. Negrin LL, Seligson D (2017) Results of 167 cases of acetabular fractures using the Kocher–Langenbeck approach: a case series. J Orthop Surg Res 12(1):66

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parker MJ, Livingstone V, Clifton R et al (2007) Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 3:CD001825

    Google Scholar 

  11. Magee C, Rodeheaver GT, Golden GT et al (1976) Potentiation of wound infection by surgical drains. Am J Surg 131:547–549

    Article  CAS  PubMed  Google Scholar 

  12. Willett KM, Simmons CD, Bentley G (1988) The effect of suction drains after total hip replacement. J Bone Jt Surg Br 70:607–610

    Article  CAS  Google Scholar 

  13. Jenny JY, Boeri C, Lafare S (2001) No drainage does not increase complication risk after total knee prosthesis implantation: a prospective, comparative, randomized study. Knee Surg Sports Traumatol Arthrosc 9:299–301

    Article  CAS  PubMed  Google Scholar 

  14. Niskanen RO, Korkala OL, Haapala J et al (2000) Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. J Arthroplast 15:567–569

    Article  CAS  Google Scholar 

  15. Ovadia D, Luger E, Bickels J et al (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplast 12:317–321

    Article  CAS  Google Scholar 

  16. Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Jt Surg Am 86-A(6):1146–1152

    Article  Google Scholar 

  17. Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed suction drain in total knee arthroplasty. A prospective, randomized study. J Bone Jt Surg Br 85:215–217

    Article  CAS  Google Scholar 

  18. Liu JM, Chen WZ, Fu BQ et al (2016 Jun) The use of closed suction drainage in lumbar spinal surgery: is it really necessary? World Neurosurg 90:109–115

    Article  PubMed  Google Scholar 

  19. Waly F, Alzahrani MM, Abduljabbar FH et al (2015) The outcome of using closed suction wound drains in patients undergoing lumbar spine surgery: a systematic review. Glob Spine J 5(6):479–485

    Article  Google Scholar 

  20. Tjeenk RM, Peeters MP, van den Ende E et al (2005) Wound drainage versus non-drainage for proximal femoral fractures. A prospective randomised study. Injury 36(1):100–104

    CAS  Google Scholar 

  21. Lang GJ, Richardson M, Bosse MJ et al (1998) Efficacy of surgical wound drainage in orthopaedic trauma patients: a randomized prospective trial. J Orthop Trauma 12(5):348–350

    Article  CAS  PubMed  Google Scholar 

  22. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and Dislocation Classification Compendium—2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma 21(Supplement 10):S1–S163

    Article  CAS  Google Scholar 

  23. Dolenc AJ, Morris WZ, Como JJ et al (2016) Limited blood transfusions are safe in orthopaedic trauma patients. J Orthop Trauma 30(12):e384–e389

    Article  PubMed  Google Scholar 

  24. Hsu JM, Hitos K, Fletcher JP (2013 Sep) Identifying the bleeding trauma patient: predictive factors for massive transfusion in an Australasian trauma population. J Trauma Acute Care Surg 75(3):359–364

    Article  PubMed  Google Scholar 

  25. Dunne JR1, Riddle MS, Danko J et al (2006 Jul) Blood transfusion is associated with infection and increased resource utilization in combat casualties. Am Surg 72(7):619–625 (discussion 625–6)

    PubMed  Google Scholar 

  26. Bini SA, Darbinian JA, Brox WT et al (2017) Risk factors for reaching the post-operative transfusion trigger in a community primary total knee arthroplasty population. J Arthroplast. https://doi.org/10.1016/j.arth.2017.10.029

    Article  Google Scholar 

  27. Slover J, Lavery JA, Schwarzkopf R et al (2017) Incidence and risk factors for blood transfusion in total joint arthroplasty: analysis of a statewide database. J Arthroplast 32(9):2684–2687

    Article  Google Scholar 

  28. King JJ1, Patrick MR, Schnetzer RE et al (2017) Multivariate analysis of blood transfusion rates after shoulder arthroplasty. J Surg Orthop Adv 26(1):40–47

    Article  PubMed  Google Scholar 

  29. Saleh A, Small T, Chandran Pillai AL et al (2014) Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009. J Bone Jt Surg Am 96(18):493–499

    Article  Google Scholar 

  30. Hsu JR, Stinner DJ, Rosenzweig SD et al (2010) Is there a benefit to drains with a Kocher–Langenbeck approach? A prospective randomized pilot study. J Trauma 69(5):1222–1225

    Article  PubMed  Google Scholar 

  31. Bjerke-Kroll BT, Sculco PK, McLawhorn AS et al (2014) The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplast 29(5):895–899

    Article  Google Scholar 

  32. Klika AK, Small TJ, Saleh AT et al (2014) Primary total knee arthroplasty allogenic transfusion trends, length of stay, and complications: nationwide inpatient sample 2000–2009. J Arthroplasty 29(11):2070–2077

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mistry JB, Gwan CU, Naziri Q et al (2018) Are allogeneic transfusions decreasing in total knee arthroplasty patients? National inpatient sample 2009–2013. J Arthroplasty 33(6):1705–1712

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Emory University School of Medicine, 57 Executive Park South, Atlanta, GA, 30329, USA

    Adam R. Boissonneault, Mara Schenker, Christopher Staley, Zachary J. Grabel, Thomas Moore Jr., William Reisman & Michael Maceroli

  2. Emory University School of Medicine, Atlanta, GA, USA

    Madeline Roorbach & Amalie A. Erwood

Authors
  1. Adam R. Boissonneault
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  2. Mara Schenker
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  3. Christopher Staley
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  4. Madeline Roorbach
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  5. Amalie A. Erwood
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  6. Zachary J. Grabel
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  7. Thomas Moore Jr.
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  8. William Reisman
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  9. Michael Maceroli
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Correspondence to Adam R. Boissonneault.

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Boissonneault, A.R., Schenker, M., Staley, C. et al. Impact of closed suction drainage after surgical fixation of acetabular fractures. Arch Orthop Trauma Surg 139, 907–912 (2019). https://doi.org/10.1007/s00402-019-03110-0

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  • DOI: https://doi.org/10.1007/s00402-019-03110-0

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