Is closed-suction drain necessary in unicompartmental knee replacement? A prospective randomised study. A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Effect of drain placed in the donor site in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with quadrupled hamstring tendons. Blood loss after total hip replacement: a prospective randomized study between wound compression and drainage. Drainage versus nondrainage in simultaneous bilateral total hip arthroplasties. No drainage does not increase complication risk after total knee prosthesis implantation: a prospective, comparative, randomized study. Closed wound drainage in shoulder surgery. Postoperative drains at the donor sites of iliac-crest bone grafts. A prospective, randomized study of morbidity at the donor site in patients who had a traumatic injury of the spine. No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty. Efficacy of surgical wound drainage in orthopaedic trauma patients: a randomized prospective trial. Postoperative drainage of knee arthroplasty is not necessary: a randomized study of 90 patients. [A prospective randomized study of wound drainage versus non-drainage in primary total hip or knee arthroplasty]. Is suction drainage necessary after total joint arthroplasty? A prospective study. Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. Efficacy of closed wound suction drainage after single-level lumbar laminectomy. Wound drainage versus non-drainage for proximal femoral fractures. A prospective randomised study. The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. The use of suction drainage in the operation of meniscectomy. The use of postoperative subcutaneous closed suction drainage after posterior spinal fusion in adolescents with idiopathic scoliosis. Wound drains in proximal femoral fracture surgery: a randomized prospective trial of 177 patients. No effect of drains on the postoperative hematoma volume in hip replacement surgery: a randomized study using scintigraphy. Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis: a prospective randomized study. [Effectiveness of postoperative drainage after bipolar sealed endoprosthetic arthroplasty for femur neck fracture. Results of a prospective randomized study of 86 cases]. Arthroscopically assisted ACL reconstruction. Is a drain necessary? The effectiveness of suction drainage in total hip arthroplasty.
In a prospective randomised trial we evaluated the use of a post-operative closed-suction drain in unicompartmental knee replacement (UKR). Seventy-eight patients were divided into two groups: one without a post-operative closed-suction drain (Group A) and one with a drain (Group B). Both groups were matched for age, sex and pre-operative haemoglobin. In group A we observed a lower day one post-operative analgesic requirement, smaller knee circumference 3 days post-operatively and less local wound complications. Drain usage in UKR resulted in no significant advantage in post-operative pain, range of motion and hospital stay. Post-operative drainage does, however, increase the cost of the procedure both in labour and equipment expenditure. No deep infections occurred in either group during the follow-up period. We conclude that avoiding post-operative closed-suction drainage in UKR does not influence the outcome. A prospective randomized study.
                To study the risk of infection, hematoma, and neurologic deficits following extensive lumbar spine surgery in patients with or without prophylactic closed wound suction drain placement.
                One randomized study assessing prophylactic drain placement in one-level lumbar spine surgery suggested that the use of a wound drain is not effective at preventing infection and may actually increase the rate of this complication. Our study was designed to determine the efficacy of closed wound suction drainage in preventing complications after extensive lumbar spine surgery.
                Eighty-three consecutive patients undergoing extensive lumbar spine surgery were prospectively randomized to one of two groups. Forty-two patients had a closed wound suction drain placed before wound closure and 41 patients did not have a drain placed. The two groups were then assessed for differences in postoperative infection rate, incidence of hematoma and neurologic deficits, operating room time, estimated blood loss, hemoglobin and hematocrit values, temperature, dressing drainage, and length of hospital stay. RESULTS.: No infections, epidural hematomas, or new neurologic deficits were encountered in either group of patients. The only significant finding was a higher temperature in the "no drain" group the first day after surgery (P = 0.0437).
                Based on the findings in this and other studies, the decision to use or not use a wound drain following lumbar spine surgery should be left to the surgeon's discretion. Little data exist on the effect of routine use of postoperative drainage after arthroscopic anterior cruciate ligament reconstruction, although clinical studies of other procedures have not shown benefit to this practice.
                Use of a postoperative drain will not result in decreased suprapatellar girth, increased range of motion, and decreased pain compared with nonuse.
                Prospective randomized clinical trial.
                Twenty-one patients undergoing arthroscopically assisted bone-patellar tendon-bone anterior cruciate ligament reconstruction were randomly assigned to receive a drain for 24 hours (12 patients) or no drain (9 patients). Data for comparison of groups were collected daily through postoperative day 7.
                Pain scores on a visual analog scale demonstrated the same improving trend over time for both treatment and control groups; however, the treatment group had significantly higher average pain scores, except on day 7. Differences in suprapatellar girth, flexion, and extension were not found to be statistically significant between groups.
                Use of a drain after arthroscopically assisted anterior cruciate ligament reconstruction provided no benefit in terms of range of motion, effusion, or pain in the early postoperative period. No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons.
                Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period.
                Randomized controlled clinical trial; Level of evidence, 1.
                Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain).
                In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84 degrees vs 69 degrees , P < .05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P < .05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P < .05), 5 (32.7 vs 36.0 cm, P < .05), and 7 (31.8 vs 35.7 cm, P < .001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, P = .001), 5 (38.46 vs 60.35, P = .001), and 7 (38.07 vs 61.43, P = .001).
                Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week. A randomized, controlled study compared the effects of wound compression with drainage after primary total hip arthroplasty. In 51 patients, an inflatable cuff was placed over the wound underneath a girdle (System Calmed, Calmed AB, Askim, Sweden). Control patients had wound drainage (n = 54). Preoperative and intraoperative variables did not differ between groups. Total blood loss was calculated using hemoglobin balance; with compression it was 1510 +/- 656 mL (mean +/- SD) and in controls 1695 +/- 712 mL (P = .13). However, less blood was transfused in the compression group (P = .05). Wound infection was seen in 2 patients with compression and in 3 controls. Deep venous thrombosis occurred in 3 controls. Wound discharge was more frequent in controls (19/54 vs 8/51; P = .04). Thus, wound compression had no obvious negative effects and reduced wound discharge and need for transfusion. It may replace drainage after total hip arthroplasty. A prospective study of 48 patients (96 hips) who had undergone primary simultaneous bilateral total hip arthroplasty was conducted to assess the effect of postoperative suction drainage on wound healing and infection. A suction drain was placed by randomization of the drained versus undrained side. The same surgical technique was used in all total hip arthroplasty wounds. Statistical analysis of the results showed significant differences with respect to drainage from the wound, soaked dressings requiring reinforcements, ecchymosis, and erythema about the wound in the group without drainage. There was no specific correlation between the incidence of wound complications and infection after total hip arthroplasty and the use or nonuse of closed-suction drainage. The hip score and range of motion of the hip were unaffected by the use or nonuse of the drains. The cost of 1 set of hemovac drains is $135 and the cost for 4-5 dressings and bed sheet changes is about $50. Although the hemovac is more expensive, the authors recommend the routine use of suction drains for wounds after primary total hip arthroplasty to reduce drainage, soaked dressings requiring reinforcement, ecchymosis and erythema around the wound, and psychological impact on the patient's fear of bleeding. Sixty patients were operated on for primary gonarthrosis by means of a cemented, posterior cruciate preserving total knee and were randomly allocated to postoperative drainage or nondrainage. The primary criterion was duration of hospital stay. Secondary criteria included serial evaluation of knee pain, knee flexion, knee circumference, calculated blood loss after 7 days, complications, reoperations, and the need for blood transfusions. There was no difference between the two groups in any of the criteria during the entire follow-up. There was a nonsignificant trend to a decreased calculated blood loss in the nondrained group and significantly less transfused blood units in the nondrained group. Lack of drainage does not increase complication risk after total knee prosthesis implantation. We therefore recommend using no routine drainage after this procedure. To evaluate the effectiveness of closed wound drainage in shoulder surgery, 300 patients were enrolled in a prospective randomized study. Three operations were studied: rotator cuff repair, anterior reconstruction for instability, and arthroplasty. One hundred patients were included in each group. All patients were evaluated for wound hematoma, infection, variation in postoperative rehabilitation caused by wound problems, and length of hospital stay. No statistical difference was found between the patients whose wounds were drained and those whose wounds were not drained. This finding existed within each category. Our data do not support the routine use of closed wound drainage in elective shoulder surgery. A prospective, randomized study was performed to assess the effectiveness of postoperative closed suction drainage. One hundred and twelve consecutive procedures involving autologous iliac-crest bone graft were performed, from December 29, 1992, to July 1, 1993, following a traumatic injury of the spine in 108 patients. Sixty of the sites from which the bone graft had been obtained were drained with a single large Hemovac device. The drains were maintained for two to five days postoperatively. The remaining fifty-two incisions were closed without a drainage device. All patients were evaluated clinically for problems with wound-healing. The incisions were considered to be healed when they had been asymptomatic for one year. Of eleven patients who had problems with wound-healing, six had been managed with a drain and five had not. The findings of this study do not support the routine use of drainage at the donor sites of iliac-crest bone grafts. The purpose of this study was to determine the utility of closed suction drainage (CSD) in elective total hip arthroplasty (THA).
                We randomized 104 elective, consecutive THAs to receive drainage (53) or no drainage (51). 60 arthroplasties were cemented and 44 hybrid.
                In the drainage group, 2 hematomas and 2 superficial wound infections occurred; there were no wound complications in the undrained group (p = 0.04). Patients receiving drainage had a greater reduction in hematocrit (10.4 vs 7.4) (p = 0.03), and longer hospital stay (5.1 days vs 4.7) (p = 0.01). At the 3-month follow-up, we found no deep wound infections in either group.
                We no longer use CSD in elective, primary, routine THA. One hundred thirty-six primary total knee arthroplasty patients were randomized for the use of closed-suction, nonreinfusable wound drains. Blood loss was identical in the drained and undrained groups. Forty percent of undrained wounds compared with 0% of drained wounds required dressing reinforcement. Sixty-nine percent of undrained wounds compared with 39% of drained wounds developed ecchymosis, measuring 92 cm2 in the undrained group and 28 cm2 in the drained group. This study concludes that a simple wound drain effectively minimizes the undesirable accumulation of blood in the surrounding soft tissues and the postoperative wound dressing after total knee arthroplasty. To study the efficacy of closed suction drainage in clean nonemergent surgical fracture fixation or bone grafting on the extremities or pelvis.
                A prospective randomized trial.
                The orthopaedic trauma service of a Level I trauma hospital.
                Patients were older than age eighteen years and undergoing clean nonemergent surgical fracture fixation or bone grafting procedures on the extremities (excluding hands and feet) or pelvis.
                The application of a surgical drain.
                Wound drainage, edema, hematoma and erythema, dehiscence, infection, and need for surgery or readmission were followed for six weeks. A univariate analysis with Student's t test for continuous variables and chi-squared analysis for all categorical data were used, with a p value of < or = 0.05 considered statistically significant.
                A total of 202 patients were randomized to 102 patients with no drain and 100 patients with a drain. There was no significant difference between the groups with regard to injury severity, systemic disease, age, body weight, physical status, or estimated blood loss. There was no significant difference between the drain and no-drain groups in any of the parameters evaluated.
                There is no significant difference between drained and nondrained wounds in clean, nonurgent orthopaedic trauma surgery. It appears that drainage systems can be safely eliminated in this group. We studied the management of postoperative drainage after total knee replacement (TKR). 90 primary total knee joint arthroplasties were prospectively randomized into 3 groups: a) no drain, b) an autotransfusion system, c) a standard disposable closed suction drainage system. We monitored hemoglobin and hematocrit values, drainage volume and transfusions (homologous and autologous), range of knee motion, knee swelling and hospital stay. Parameters were recorded preoperatively, days 0-8 and 4 months postoperatively. No significant differences were seen between the groups in any of the parameters measured. The results show no benefit from using postoperative drainage systems in knee arthroplasties. Savings of SEK 400 (USD 55) per patient would have resulted if drains had not been used at all. Drainage of the operative wound following total hip or knee replacement (THR, TKR) is usually performed to avoid hematoma formation. A certain amount of blood is lost through the drain. The necessity of wound drainage has been questioned, with a view towards blood saving, although most surgeons have not abandoned drainage for fear of local complications. A prospective randomized study was undertaken to compare drainage and non-drainage following THR/TKR in terms of blood-saving and local complications.
                A total of 256 patients undergoing primary THR (152) or TKR (104) were randomly allocated to undergo either suction drainage or no drainage of the wound: there were 76 drained and 76 non-drained THR's, 52 drained and 52 non-drained TKR's. Blood loss was calculated in each patient from the postoperative drop in hematocrit values; the amounts of blood lost intra-operatively and in the drain were also recorded, as was the number of blood units transfused in each patient. Swelling, hip or knee range of motion and wound healing were monitored over the first 6 weeks after operation, and any local or systemic complication was recorded.
                No significant difference was noted between drained and non-drained THR's/TKR's regarding swelling, recovery of hip or knee motion, wound healing, other local or systemic complications. Following THR, no significant difference was noted between calculated blood losses or transfusion requirements in drained versus non-drained patients. Patients with drains lost on average 1 942 ml of blood versus 1 766 ml for non-drained patients; they received on average 1.18 units of transfused blood versus 1.32 units for patients without drains. The differences are not significant. Following TKR, total blood loss was significantly higher in non-drained than in drained patients (1 983 ml versus 1 590 ml) and the amount of blood transfused was also significantly higher in non-drained patients (0.98 unit versus 0.54 unit).
                Following primary hip or knee arthroplasty, the use of wound drainage did not lead to increased blood loss, and non-drainage did not lead to significant wound healing problems but did not reduce blood loss and transfusion requirements. It was even associated, following TKR, with greater blood loss and transfusion. Such data may therefore be used to support drainage as well as non-drainage following THR or TKR. Avoiding drainage may be interesting in terms of cost, but the benefit is marginal; it also eliminates one possible source of retrograde wound infection. Systematic wound drainage following THR or TKR is essentially a tradition. This study shows that it can safely be dispensed with in a number of cases. A prospective evaluation of 98 patients who had undergone a total hip or knee arthroplasty was conducted to assess the effect of postoperative suction drainage. Sixty-six patients undergoing elective total hip arthroplasty and 32 patients undergoing total knee replacement were randomly allocated to undergo either suction drainage or no drainage of the wound. Statistical analysis of the results showed no difference in wound healing, severity of wound haematoma, postoperative blood transfusion requirement, range of motion and duration of the hospitalization between the two groups. We conclude that the use of closed suction drainage provides no apparent advantage after uncomplicated total hip or knee arthroplasty. The efficacy of closed suction drains following joint arthroplasty operations was prospectively evaluated in a randomized manner. All 88 patients allotted to primary knee or hip arthroplasty operations during a 6-month period were included in the study. Drains were used in 32 of 58 patients following total knee arthroplasty and in 18 of 30 total hip arthroplasties. No statistical difference was found in the hemoglobin levels measured following surgery and in the number of patients requiring blood transfusions between the two groups after total hip arthroplasty (P = .06). The power of the test to detect a difference of 2 g% in hemoglobin levels is 94%. Two patients from each group had a transient serous discharge for 3 to 4 days following surgery and none had wound infections. Significantly more blood transfusions were needed in patients with drains following total knee arthroplasty compared with patients without drains (0.7 unit per patient versus 0.2 unit per patient, P = .005) to maintain the same hemoglobin blood levels. Patients with no drains had significantly more transient sterile serous wound discharge than patients with drains (38.4% vs 12.5%, P = .02). Superficial wound infection necessitating antimicrobial medication developed in one patient with drains and in no patients in the other group. These results suggest that drains may not be needed following total hip arthroplasty. The more common serous wound discharge may be of some concern when drains are not used following total knee arthroplasty. The use of closed suction drainage after spinal surgery remains controversial. The purpose of this study was to determine the indications for closed suction drainage after single-level lumbar surgery. Two hundred patients who were scheduled to undergo single-level lumbar surgery without fusion were prospectively randomized into two groups. One group had a closed wound suction drain placed deep to the lumbodorsal fascia before routine closure, whereas the second group had no drain placed. Hemostasis was achieved in all patients before the surgeon had knowledge of the randomization outcome. All drains were removed on the 2nd postoperative day, and the amount of drainage was recorded. After surgery, the patients were evaluated for signs and symptoms of continued wound drainage, hematoma/seroma formation, and/or infection as well as evidence of an acquired neurologic deficit. One hundred three patients had a drain placed before closure and two patients developed postoperative wound infection, both of which were successfully treated with orally administered antibiotics. Of the 97 patients who had no drain placed after the surgical procedure, one patient developed a postoperative wound infection that was treated with surgical incision and drainage, as well as intravenously administered antibiotics. Statistical analysis revealed that the presence or absence of a drain did not affect the postoperative infection rate. No new neurologic deficits occurred in any postoperative patient. The use of drains in single-level lumbar laminectomy without fusion did not affect patient outcome. There was no significant difference in the rate of infection or wound healing and no patient developed a postoperative neurologic deficit. The purpose of this prospective randomised study was to examine whether routine drainage in surgery for traumatic hip fractures is useful.
                At the end of surgery for hip fractures, 200 consecutive patients (51 men, 149 women) were randomised to receive suction drainage or not. The status of wound healing was evaluated, with specific reference to haematoma formation or wound infection. Indices of blood loss were the average blood loss during operation, a decrease in the haemoglobin level, fluid collected by the drain, and blood transfusion.
                The severity of wound haematoma and the number of wound infections was not significantly different between the two groups. The average blood loss during operation was 172 ml in the drainage group and 179 ml in the non-drainage group. The volume of drainage fluid was 146 ml. The haemoglobin concentration decreased by 1.4 mg/dl in the drainage group and by 1.3 mg/dl in the non-drainage group (P = 0.83). During admission, 55 patients in the drainage group received 2.5 units of blood and 50 patients in the non-drainage group received 2.7 units.
                The severity of wound haematoma does not lead to statistically significant differences in wound infection rate. The routine use of suction drains may not prevent wound infections. We prospectively randomised 100 patients undergoing cemented total knee replacement to receive either a single deep closed-suction drain or no drain. The total blood loss was significantly greater in those with a drain (568 ml versus 119 ml, p < 0.01; 95% CI 360 to 520) although those without lost more blood into the dressings (55 ml versus 119 ml, p < 0.01; 95% CI -70 to 10). There was no statistical difference in the postoperative swelling or pain score, or in the incidence of pyrexia, ecchymosis, time at which flexion was regained or the need for manipulation, or in the incidence of infection at a minimum of five years after surgery in the two groups. We have been unable to provide evidence to support the use of a closed-suction drain in cemented knee arthroplasty. It merely interferes with mobilisation and complicates nursing. Reinfusion drains may, however, prove to be beneficial. A prospective trial has been carried out to determine the value of suction drainage in the operation of meniscectomy. One hundred operations were analysed, in half of which drains had been used. The use of the drain could not be shown to result in any sustained advantages. The demand for analgesics after the operation was reduced but not to a statistically significant level. The size of the early effusion was significantly reduced, but this benefit was lost when the knee was mobilised. The return of power to the quadriceps and of movement to the knee were not hastened. The average volume of fluid drained was 134 millilitres and it has been shown that forty-eight hours is a suitable time for removal of the drain. The use of suction drainage is not advocated for the uncomplicated operation of meniscectomy. BACKGROUND The purpose of this prospective study was to assess the impact of closed suction drainage on transfusion requirements, frequency of dressing changes, and wound healing following posterior spinal fusion in adolescents with idiopathic scoliosis. METHODS Thirty patients were randomly assigned to one of two groups: drain or no drain. Although the group with drains received more postoperative autologous blood transfusions than the group with no drains (0.88 vs 0.5 unit), the difference was not statistically significant (P = 0.2131). In the undrained group, 58% of the patients had moderate to completely saturated dressings on the second postoperative day compared with only 17% of patients in the drained group. Three of 12 patients in the undrained group demonstrated a wound complication rate compared with no complications in the drained group. CONCLUSION In conclusion, subcutaneous closed suction drainage can improve immediate postoperative wound care without significantly increasing blood loss and transfusion requirements for patients undergoing surgery for idiopathic scoliosis. We report on a prospective randomized trial on the effect of wound drains on wound healing following surgery for proximal femoral fractures. One hundred and seventy-seven consecutive patients admitted to Queen's Medical Centre Nottingham, undergoing AO dynamic hip screw (DHS) or hemiarthroplasty were randomized whether or not to receive wound drainage. Wound healing was assessed in terms of ultrasound examination, the ASEPSIS wound score system and overt infection rates. All patients were followed up at 6 weeks and 6 months. Ultrasound examinations showed that drains were indeed ineffective in preventing haematoma formation, the first time this has been demonstrated objectively. However, using drains failed to prevent late seroma formation. Patients who received wound drainage showed statistically better wound healing on the ASEPSIS wound scoring system and a reduced infection rate. The ASEPSIS scores on day 2 and 5 postoperatively proved an accurate predictor of poor wound healing. This study conflicts with previous smaller studies which failed to show an effect of wound drainage upon wound healing, and strongly supports the use of wound drains. In a prospective randomized study we used erythrocyte scintigraphy to evaluate whether drainage reduced the hematoma volume after total hip arthroplasty. 12 patients were left without drains and 10 patients had two drains inserted, one below the fascia and one subcutaneously. We used tomographic registration (SPECT) to calculate the volume of the hematoma (erythrocytes) about 22 hours after surgery and found that drainage did not reduce the volume, but increased the need for blood transfusion. In a prospective, randomized study, 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications, or range of motion. Although there was more soaked dressing requiring reinforcements in the groups without drainage, as a result of this study, we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis. nan We report on the results of a prospective randomised controlled trial to evaluate the use of an intra-articular drain following arthroscopically assisted ACL reconstruction using patellar tendon autograft. Forty-nine patients were recruited for the trial and randomised into receiving or not receiving a drain following surgery. An independent observer who was blinded for the use of the drain assessed the knees for swelling, range of movement (ROM) and pain at 2, 4 and 6 weeks postoperatively. Muscle strength was assessed at 12 weeks following surgery using the KIN COM III isometric dynamometer. We found that the knees that were drained following surgery initially had less swelling and a better ROM. However, at 4 weeks this difference had disappeared. At 3 and 6 months, there was no functional difference between the two groups. We recommend that no drain be used following ACL reconstruction as removal of the drain is uncomfortable and carries theoretical and avoidable risks. nan
There is insufficient evidence from randomised trials to support the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials with larger patient numbers are required for different operations before definite conclusions can be made for all types of orthopaedic operations.