Alexander Vadimovich Gubin1, Oksana Germanovna Prudnikova2, Koushik Narayan Subramanyam3, Alexander Vladimirovich Burtsev4, Maxim Viktorovich Khomchenkov4, Abhishek Vasant Mundargi5. 1. Federal State Budgetary Institution Russian Ilizarov Scientific Center for "Restorative Traumatology and Orthopaedics", Ministry of Healthcare, Russian Federation, Kurgan, Russia. 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. 3. Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India. drkoushik@hotmail.com. 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. 5. Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India.
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. These slides can be retrieved under Electronic Supplementary Material.
RCT Entities:
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. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Closed suction drain; Perioperative blood loss; Spine surgery
Authors: Zorica Buser; Ki-Eun Chang; Ronald Kall; Blake Formanek; Anush Arakelyan; Sarah Pak; Betsy Schafer; John C Liu; Jeffrey C Wang; Patrick Hsieh; Thomas C Chen Journal: Eur Spine J Date: 2022-02-11 Impact factor: 2.721