Which Criterion for Wound Drain Removal is Better Following Posterior 1-Level or 2-Level Lumbar Fusion With Instrumentation: Time Driven or Output Driven?

Study Design: Case-control study. Objectives: To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. Methods: 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. Results: The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II ( P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance ( P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups ( P > 0.05). Conclusions: This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.

Bipolar cautery versus conventional suture ligation of vascular pedicles in thyroidectomy: a comparative clinical study

Background: Thyroidectomies are commonly performed surgeries worldwide. With better knowledge of anatomy and major advent of energy devices, morbidity of thyroidectomy has drastically declined. Two main globally followed procedures to deal with vascular pedicles are conventional suture ligation and electro cautery devices. The objectives of the present study are to compare classical suture ligation and bipolar cautery of vascular pedicles in thyroidectomy, in terms of duration of procedure, hospitalization and operative complications.Methods: Retrospective observational comparative study was conducted in 100 patients who underwent total thyroidectomy in our institution for a period of 3 years from 4 September 2017. Non random sampling techniques applied on all consecutive patients who are eligible according to the inclusion criteria. Patients divided into two groups used: suture ligation (n=50), bipolar cauterization (n=50). The main outcomes measured were surgical and hospitalization time; duration of wound drain and post-operative complications (hoarseness, hypocalcemia and seroma).Student t test (for quantitative) and Chi Squaretest (for qualitative) applied for analysis.Results: Post-operative complications are present more in the suture ligation group (66%) compared to bipolar cautery (24%). The procedure time in ligation is a 131.6±17.7 minutes which is, significantly higher compared to bipolar cautery (97±7.5 minutes). Duration of hospital stay is more in suture ligation (6±0.8 days) compared to bipolar cautery (4.9±1.3 days).Conclusions: As per our study, bipolar cauterization has significant reduction of surgery time, duration of hospital stay and postoperative complications viz seroma, hoarseness of voice, hypocalcemia compared to conventional suture ligation.

Efficacy of postoperative drainage in total knee arthroplasty: Review of the literature

Postoperative drainage after total knee arthroplasty (TKA) is an established routine procedure for orthopedic surgeries, and is considered a useful practice in postoperative, but the use of drainage is controversial. Our study aims to clarify this aspect of knee prosthetic surgery. A systematic review of the literature was performed in the electronic databases to investigate the risks and the benefits of wound drainage in total knee arthroplasty: 30 articles were included in our review for eligibility. After the analysis of the literature performed, we found no significant advantages related with the use of wound drain following total knee replacement (TKR) in terms of pain, transfusion rate, blood loss, swelling, postoperative range of motion, wound complications, deep infection and hospital stay, while no drainage means a significant cost saving compared to drainage use. Thus, the use of drainage after TKA cannot be justified on the basis of the results of this study.

Postoperative Cerebrospinal Fluid Leak Rates with Subfascial Epidural Drain Placement after Intentional Durotomy in Spine Surgery

Study Design Retrospective chart review. Objective Postoperative cerebrospinal fluid (CSF) leak is a known complication of intraoperative durotomy. Intraoperative placement of subfascial epidural drains following primary dural repair has been proposed as a potential management strategy to prevent formation of CSF cutaneous fistula and symptomatic pseudomeningocele. Here we describe our experience with subfascial drain after intentional durotomy. Methods Medical records of patients who underwent placement of subfascial epidural drains during spinal procedures with intentional intraoperative durotomies over a 4-year period at two institutions were retrospectively reviewed. Primary outcomes of interest were postoperative CSF cutaneous fistula or symptomatic pseudomeningocele formation. Results Twenty-five patients were included. Mean length of follow-up was 9.5 months. Twelve patients (48%) underwent simultaneous arthrodesis. The average duration of the drain was 5.3 days with average daily output of 126.5 mL. Subgroup analyses revealed that average drain duration for the arthrodesis group was 6.33 days, which is significantly greater than that of the nonfused group, which was 3.7 days ( p = 0.016). Similarly, the average daily drain output for the arthrodesis subgroup at 153.1 mL was significantly higher than that of the nonfused subgroup (86.8 mL, p = 0.04). No patient developed postoperative CSF cutaneous fistula or symptomatic pseudomeningocele or had negative sequelae associated with overdrainage of CSF. One patient had a delayed wound infection. Conclusions The intraoperative placement of subfascial epidural drains was not associated with postoperative development of CSF cutaneous fistula, symptomatic pseudomeningocele, overdrainage, or subdural hematoma in the cases reviewed. Subfascial closed wound drain placement is a safe and efficacious management method after intentional spinal durotomies. It is particularly helpful in those who undergo simultaneous arthrodesis, as those patients have statistically higher daily drain output and longer drain durations.