The usage of drainage after primary total hip or knee arthroplasty: best evidence selection and risk of bias considerations

Background Numerous systematic reviews investigating the benefit of the usage of drainage after primary total hip or knee arthroplasty have been published with divergent conclusions. We aim to determine the best available evidence and consider risk of bias of these articles and to provide recommendations. Methods A systematic search of systematic reviews published through to May 2020 was performed in MEDLINE, EMBASE and Cochrane library. Methodological quality, risk of bias and best evidence choice of included articles were evaluated by AMSTAR instrument, ROBIS tool and Jadad decision algorithm, respectively. We selected systematic reviews with high methodological quality and low risk of bias ultimately as best evidence. Results Twelve meta-analyses were included lastly. According to the ROBIS tool, seven of the included systematic reviews were with low risk of bias and five with high risk of bias. The Jadad decision algorithm suggested that two reviews conducted by Zan et al. for hip and Si et al. et al. for knee were selected as the best evidence, with highest AMSTAR score and low risk of bias. Conclusions Ten systematic reviews were included as low-quality with only two high-quality studies. Based on the current available evidence, we have insufficient confidence to draw conclusion that whether to use closed suction drainage for both total knee and hip arthroplasty. To verify the necessity and benefit of using closed suction drainage after primary total knee and hip arthroplasty, and develop exact recommendations, further studies are still required.

Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection

Background Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.1 Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection. Results The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be Escherichia coli. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI. Conclusion Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.

Compare the Frequency of Surgical Site Infections in Patients Undergoing Hip Surgery with Closed Suction Drain Placed At Surgical Site and Without Drain

Introduction: Hip trauma is a debilitating event that leads to a major limitation in patient’s functional ability. The incidence of hip fractures increases with advancing age and are more common in old age individuals. Closed-suction drainage has been routinely used in total hip arthroplasty to prevent hematoma formation and surgical site infections (SSI). Objective: To compare the frequency of surgical site infections in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Study Design: Randomized controlled trial. Place and Duration: The study was completed at department of Orthopedic Surgery Unit III, Bolan Medical College Hospital Quetta, Pakistan. The duration of study was from 1-April-2016 to 31-October-2017. Subjects and Methods: A total number of 176 patients who underwent hip arthroplasty were included in this study. Group A (n=88) patients underwent hip surgery with placement of drain and Group B patients underwent hip surgery without the placement of drains. Data analysis was carried out using SPSS v20.0. Chi-square test was applied to compare surgical site infections in drain group and without drain group. Effect modifiers were controlled by stratification. Post stratification Chi-square test was applied taking P-value <0.05 as significant. Results: The mean age of patients in this study was 42.26 (SD 9.86) years. There were 135 males (76.7%) patients in this study and 41 (23.3%) female patients. The mean duration of fracture was 39.41 (SD 7.74) days. There were 63 (35.8%) patients who presented with greater/lesser trochanteric fractures, 64 (36.4%) presented with sub-trochanteric fractures and 49 (27.8%) were presented with inter-trochanteric fractures. SSIs occurred in 7 patients in whom drain was inserted after surgery and in only 2 patients in whom drain was not inserted (p-value 0.08). There was no effect of confounder variables on the occurrence of SSIs. Conclusion: The risk of surgical site infections is same in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Keywords: Hip fractures, Hip arthroplasty, Closed suction drains, Surgical site infections.

A COMPARATIVE STUDY OF SUBCUTANEOUS SINGLE CLOSED SUCTION DRAIN VERSUS SIMPLE CLOSURE IN EMERGENCY MIDLINE LAPAROTOMY WOUNDS

Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs).. Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane. This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases.

The impact of open vs closed suction on cardio- respiratory parameters in mechanically ventilated patients

Suctioning of the endotracheal tube in ventilated patients is one of the ways to maintain the airway open. There arevarious risks associated with this procedure. Suctioning methods that are appropriate for the situation can help to avoid acute problems. The purpose of this study was to compare the effects of open vs closed suction on cardiorespiratory parameters in patients on mechanical ventilations. Patients hospitalized to Neuro-ICU and Medical ICU with ventilator support was studied in a non-randomized clinical trial with a time series study design. Sixty samples were chosen using a convenient sampling procedure, including 30 for open suction and 30 for closed suction. Before and during suction, data such as demographic factors and cardio-respiratory parameters such as respiratory rate, heart rate, mean arterial pressure, and SpO2 were measured. In this study, statistically significant changes (p=0.001) in Mean Arterial Pressure (MAP) and SpO2 were identified when open and closed suction systems were compared. According to the findings, closed suction has a significant favourable impact on cardiopulmonary parameters. Keywords: Cardio Respiratory parameters, mechanical ventilation, SpO2, Mean Arterial Pressure (MAP), opensuction, closed suction