Use of Drains in Spine Surgery Systematic Review & Meta-Analysis
Authors: Abu El-Ela Amr Abdel Kader Hammad , Habib el-Zahlawy Hany Nabil , Talkhan Mohamed Abdullah 
Published: July 2024

Abstract

Background
Wound suction drains have been used to decrease the rate of postoperative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. Although the use of surgical drains dates back to the years of Hippocrates, in the orthopedic literature these drains have not been shown to be beneficial in decreasing the rates of these complications, especially in orthopedic procedures including fracture fixation or arthroplasty surgeries. However, these drains are still commonly used throughout the orthopedic community, including spine surgery.

Aim of the Work
This study aims to review the use of closed suction drains in spine surgery. It aims to perform a systematic review and meta-analysis of the outcome of use of drains, their method and provide intervention recommendation by the best available evidence.

Material and Methods
We followed the PRISMA statement guideline during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Science Direct till September 2021 relevant keywords. We used the following search strategy for searching different databases. “Wound drain” OR “Suction drainage” OR “Drain” OR “Spine Surgery” OR “Spine” OR “SSI” OR “Surgical Site Infection” OR “Hematoma”) AND (“Vertebral Column” OR “Column, Vertebral” OR “Columns, Vertebral” OR “Vertebral Columns” OR “Spinal Column” OR “Column, Spinal” OR “Columns, Spinal” OR “Spinal Columns” OR Vertebra OR Vertebrae). All the references of the included studies were searched for relevant studies.

Results
In contrast to other spine procedures, posterior spinal fusion as a surgical treatment for adolescent idiopathic scoliosis necessitates big skin incisions, a lengthy operating duration, and a higher rate of blood transfusion. This meta-analysis comprised four studies. Surprisingly, drains had no effect on total blood loss, the rate of post-surgical infection, the rate of post-operation hematoma, or hospital stay. The drain group required greater blood transfusion than the non-drain group, according to. A drain could also result in a post-durotomy fistula. Drain use is not required after intra-dural spinal cord tumor surgery. Regarding the difference in hemoglobin between preoperative and day 3 postoperative 3 studies, no difference was found between the drain group and the no drain group in all spine surgeries.

Conclusion
The routine use of a drain in post-operative spine surgery appears to have no effect on the likelihood of post-operative surgical site infections or post-operative epidural hematoma, according to this study. It does, however, increase total estimated blood loss without lowering hemoglobin levels, and has no effect on hospital stay length. To further strengthen any meta- analysis in the future, high-quality studies addressing their use in the spine are require.