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Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial

European Spine Journal volume 28, pages 146–154 (2019)Cite this article

Abstract

Purpose

To explore the role of closed suction drain in multi-level posterior spinal surgery.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O (2012) Postoperative infections of the lumbar spine: presentation and management. Int Orthop 36(2):439–444. https://doi.org/10.1007/s00264-011-1427-z

    Article  PubMed  Google Scholar 

  2. Awad JN, Kebaish KM, Donigan J, Cohen DB, Kostuik JP (2005) Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surg Br 87(9):1248–1252

    Article  CAS  PubMed  Google Scholar 

  3. American Academy of Orthopaedic Surgeons Patient Safety Committee, Evans RP (2009) Surgical site infection prevention and control: an emerging paradigm. J Bone Joint Surg Am 91(Suppl 6):2–9. https://doi.org/10.2106/JBJS.I.00549

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  5. Arabshahi KS, Koohpayezade J (2006) Investigation of risk factors for surgical wound infection among teaching hospitals in Tehran. Int Wound J 3(1):59–62

    Article  PubMed  Google 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):26–30

    Article  PubMed  Google Scholar 

  7. Raleigh E, Hing CB, Hanusiewicz AS, Fletcher SA, Price R (2007) Drain clamping in knee arthroplasty, a randomized controlled trial. ANZ J Surg 77(5):333–335

    Article  PubMed  Google 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):CD001825

    Google Scholar 

  9. Poorman CE, Passias PG, Bianco KM, Boniello A, Yang S, Gerling MC (2014) Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions. Int J Spine Surg 1:8. https://doi.org/10.14444/1034

    Article  Google Scholar 

  10. Brown MD, Brookfield KF (2004) A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976) 29(10):1066–1068

    Article  Google Scholar 

  11. Payne DH, Fischgrund JS, Herkowitz HN, Barry RL, Kurz LT, Montgomery DM (1996) Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord 9(5):401–403

    Article  CAS  PubMed  Google Scholar 

  12. Blank J, Flynn JM, Bronson W, Ellman P, Pill SG, Lou JE, Dormans JP, Drummond DS, Ecker ML (2003) The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis. J Spinal Disord Tech 16(6):508–512

    Article  PubMed  Google Scholar 

  13. Waly F, Alzahrani MM, Abduljabbar FH, Landry T, Ouellet J, Moran K, Dettori JR (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. https://doi.org/10.1055/s-0035-1566288

    Article  Google Scholar 

  14. Liu Y, Li Y, Miao J (2016) Wound drains in posterior spinal surgery: a meta-analysis. J Orthop Surg Res 22:11–16. https://doi.org/10.1186/s13018-016-0351-8

    Article  Google Scholar 

  15. Patel SB, Griffiths-Jones W, Jones CS, Samartzis D, Clarke AJ, Khan S, Stokes OM (2017) The current state of the evidence for the use of drains in spinal surgery: systematic review. Eur Spine J 26:2729–2738. https://doi.org/10.1007/s00586-017-4983-0

    Article  PubMed  Google Scholar 

  16. Gibon E, Courpied JP, Hamadouche M (2013) Total joint replacement and blood loss: what is the best equation? Int Orthop 37(4):735–739

    Article  PubMed  PubMed Central  Google Scholar 

  17. Power calculator for continuous outcome equivalence trial. https://sealedenvelope.com/power/continuous-superiority Accessed 1 Oct 2017

  18. Diab M, Smucny M, Dormans JP, Erickson MA, Ibrahim K, Lenke LG, Sucato DJ, Sanders JO (2012) Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 37(11):966–973. https://doi.org/10.1097/BRS.0b013e31823bbf0b

    Article  Google Scholar 

  19. Liu X, Zhang X, Chen Y, Wang Q, Jiang Y, Zeng B (2011) Hidden blood loss after total hip arthroplasty. J Arthroplasty 26(7):1100–1105. https://doi.org/10.1016/j.arth.2010.11.013

    Article  Google Scholar 

  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–CR66

    PubMed  Google 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

    Article  PubMed  Google Scholar 

  22. von Eckardstein K, Dohmes J, Rohde V (2016) Use of closed suction devices and other drains in spinal surgery: results of an online. Germany-wide questionnaire. Eur Spine J 25(3):708–715. https://doi.org/10.1007/s00586-015-3790-8

    Article  Google Scholar 

  23. Mirzai H, Eminoglu M, Orguc S (2006) Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech 19(3):171–177

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

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Affiliations

  1. Federal State Budgetary Institution Russian Ilizarov Scientific Center for “Restorative Traumatology and Orthopaedics”, Ministry of Healthcare, Russian Federation, Kurgan, Russia

    Alexander Vadimovich Gubin

  2. Scientific and Clinical Laboratory of Axial Skeleton Pathology and Neurosurgery, Head of Trauma and Orthopedic Dept. No 10, Federal State Budgetary Institution Russian Ilizarov Scientific Center for “Restorative Traumatology and Orthopaedics”, Ministry of Healthcare, Russian Federation, Kurgan, Russia

    Oksana Germanovna Prudnikova

  3. Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India

    Koushik Narayan Subramanyam & Abhishek Vasant Mundargi

  4. Scientific and Clinical Laboratory of Axial Skeleton Pathology and Neurosurgery, Surgeon of Trauma and Orthopedic Dept. No 10, Federal State Budgetary Institution Russian Ilizarov Scientific Center for “Restorative Traumatology and Orthopaedics”, Ministry of Healthcare, Russian Federation, Kurgan, Russia

    Alexander Vladimirovich Burtsev & Maxim Viktorovich Khomchenkov

Authors
  1. Alexander Vadimovich Gubin
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  2. Oksana Germanovna Prudnikova
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  3. Koushik Narayan Subramanyam
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  6. Abhishek Vasant Mundargi
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Correspondence to Koushik Narayan Subramanyam.

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Gubin, A.V., Prudnikova, O.G., Subramanyam, K.N. et al. Role of closed drain after multi-level posterior spinal surgery in adults: a randomised open-label superiority trial. Eur Spine J 28, 146–154 (2019). https://doi.org/10.1007/s00586-018-5791-x

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  • DOI: https://doi.org/10.1007/s00586-018-5791-x

Keywords

  • Spine surgery
  • Perioperative blood loss
  • Closed suction drain