CLOSED SUCTION DRAINAGE AFTER ORTHOPAEDIC SURGERY: IS IT NECESSARY?

Abstract

The aim of this meta-analysis was to determine based on evidence from all randomised controlled trials whether closed suction drainage is preferable to no drainage for all types of Orthopaedic surgery. Trials were identified by a search strategy developed by the Cochrane Collaborative involving hand searching of major journals and computer aided searching of other databases.

Twenty-nine studies were identified but nine were excluded owing to problems with study design or under-reporting of outcomes. Twenty studies involving 2749 patients with 2946 wounds were included in our analysis. These studies included 566 THRs, 860 TKRs, 333 proximal femoral fractures, 287 non-emergency fractures and 900 other procedures.

Two reviewers independently extracted data from the papers. Methodology of the studies was assessed using a nine point scoring system. Generally the studies scored poorly, possibly owing to under-reporting of outcomes.

No study clearly differentiated against deep and superficial wound infections therefore all wound infections were considered together. No differences between the drained and the undrained groups was noted for wound infection overall or in any of the operative sub-groups. Similarly no difference was found for the outcomes of wound haematomas, infection, wound dehiscence, transfusion requirements, limb swelling, venous thrombosis, mortality or hospital stay.

There was a tendency to a higher re-operation rate for wound healing complications and significantly more patients required transfusion in the drained group. The only benefit that was shown in favour of the use of drains was that significantly more patients in the undrained group required dressing reinforcement.

Based on the randomised, controlled trials to date, the routine use of closed suction drainage in Orthopaedic surgery is questionable.