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Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

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Abstract

Study design

Systematic review, meta-analysis, evidence synthesis.

Objectives

To analyse the literature evidence available to support the usage of wound drain in various scenarios of spine surgery and provide an evidence summary on the surgical practice.

Materials and methods

We conducted independent and duplicate electronic database searches adhering to PRISMA guidelines in PubMed, Embase, and Cochrane Library till April 2020. Quality appraisal was done as per Cochrane ROB tool, and evidence synthesis was done as per GRADE approach. Five domains of spine surgery with associated key questions were identified. Evidence tables were generated for each question and critical appraisal done as per the GRADE approach.

Results

Twenty-three studies (9—RCTs, 4—prospective studies, 10—retrospective studies) were included. Analysis of studies in cervical spine either by anterior or posterior approach and single/multilevel thoracolumbar spinal surgeries did not show any evidence of reduction in surgical site infection (SSI) or haematoma formation with the use of drain. Deformity correction surgeries and surgeries done for trauma or tumour involving spine also did not find any added benefit from the use of wound drains despite increasing the total blood loss.

Conclusion

Evidence from this review suggests that routine use of drain in various domains of spine surgery does not reduce the risk of SSI and their absence did not increase the risk of haematoma formation. The current best evidence is presented with its limitations. High-quality studies to address their use in spine surgeries in cervical, trauma, and tumour domains are required to further strengthen the evidence synthesised from available literature.

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Authors and Affiliations

  1. Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India

    Sathish Muthu

  2. Institute of Orthopaedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India

    Eswar Ramakrishnan

  3. Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, India

    Karthick Kumar Natarajan

  4. Ganga Hospitals, Coimbatore, Tamil Nadu, India

    Girinivasan Chellamuthu

  5. Orthopaedic Research Group, Coimbatore, Tamil Nadu, India

    Sathish Muthu, Eswar Ramakrishnan, Karthick Kumar Natarajan & Girinivasan Chellamuthu

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  1. Sathish Muthu
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  2. Eswar Ramakrishnan
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  4. Girinivasan Chellamuthu
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Correspondence to Sathish Muthu.

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Muthu, S., Ramakrishnan, E., Natarajan, K.K. et al. Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary. Eur Spine J 29, 2111–2128 (2020). https://doi.org/10.1007/s00586-020-06540-2

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  • DOI: https://doi.org/10.1007/s00586-020-06540-2

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