Comparison of drain versus no-drain thyroidectomy: a meta-analysis.

Despite minimal evidence, thyroid drains are routinely used as a precaution against hematoma in thyroidectomy. We undertook the present meta-analysis to evaluate the patient outcomes associated with post-surgical drainage, and whether it offers any advantage over no drainage in patients undergoing thyroidectomy. Randomized and two-arm studies comparing the efficacy of total or partial thyroidectomy with or without post-surgery drainage, in patients undergoing thyroid surgery were included. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 22, 2015, using the terms, "thyroidectomy, subtotal thyroidectomy, total thyroidectomy, drainage, thyroid cancer, and goiter." The primary outcome of interest includes postoperative complications such as infection, hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, seroma, and duration of hospital stay. 14 studies comprising of 1927 patients were included in the present analysis. The overall analysis revealed that patients in the drain group were more likely to have a higher postoperative infection rate than no-drain group (pooled OR = 2.94, 95 % CI 1.27-6.85, P = 0.012). Similarly, patients in the drain group had a longer hospital stay in comparison to those in the no-drain group (pooled difference in mean = 1.16, 95 % CI 0.72-1.59, P < 0.001). No statistically significant differences between the groups were found for hematoma, hemorrhage, hypoparathyroidism, recurrent laryngeal nerve palsy, and seroma. In conclusion, the current practice of post-surgical drainage in thyroidectomy did not offer any significant advantage. On the contrary, post-surgical infection rate and duration of hospital stay was higher in patients in the drain group.