title: Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana.
abstract: OBJECTIVE
  To determine the optimum period for passive post-mastectomy drainage in Accra, Ghana, comparing early (day 4) to late (day 10) drain removal.
  
  
  METHODS
  Randomised prospective clinical study.
  
  
  METHODS
  Surgical Department, Korle Bu Teaching Hospital, Accra, Ghana
  
  
  METHODS
  Patients with breast cancer scheduled for total mastectomy and level 11 axillary clearance.
  
  
  METHODS
  Patients were randomised to one of the two groups: early (day 4) and late (day 10) passive drainage.
  
  
  METHODS
  Duration of hospital stay, seroma formation and postoperative wound infection.
  
  
  RESULTS
  Forty five patients had 4-day drainage and 42 had 10-day drainage. Late removal of drains (Day 10) was associated with a significantly higher drainage (1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Late removal, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspirate volumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Early removal had a shorter hospital stay of 6.2 (+/-1.52) days compared to 11.07 (+/- 0.76) days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There was a low incidence of seromas when drainage was <30 ml/day at the time of drain removal.
  
  
  CONCLUSIONS
  Post-mastectomy passive drains may be removed when drainage is <30 ml in 24 hours. When there is a persistent large volume of axillary drainage, patients should be counselled about the relative risks of early and late drain removal. For patients who do not find seroma aspiration unacceptable, early (day 4) removal appears preferable to late (day 10) removal of drains.
authors.affiliation: Department of Surgery, University of Ghana Medical School, PO Box 4326, Accra, Ghana.
authors.forename: J N A
authors.initials: JN
authors.lastname: Clegg-Lamptey
authors.forename: J C B
authors.initials: JC
authors.lastname: Dakubo
authors.forename: W M
authors.initials: WM
authors.lastname: Hodasi
mesh_terms: D000328:Adult; D000368:Aged; D001826:Body Fluids; D004322:Drainage / Q000379:methods*; D005869:Ghana; D006801:Humans; D007902:Length of Stay; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D012306:Risk; D012307:Risk Factors; D049291:Seroma; D013997:Time Factors; D014945:Wound Healing