Is closed-suction drainage necessary for single-level lumbar decompression?: review of 560 cases.
BACKGROUND
Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications.


OBJECTIVE
We evaluated the efficacy of closed-suction drainage in single-level lumbar decompression surgery.


METHODS
We retrospectively reviewed 560 patients who underwent single-level lumbar decompression or discectomy. We routinely used closed-suction drainage in all spinal surgeries until July 2003, and thereafter, we did not use drains in single-level lumbar decompression surgery. These two groups (298 patients in the group that received drains, 262 in the group that did not receive drains) were compared for rates of wound infection and epidural hematoma.


RESULTS
Mean operating time (55 versus 56 minutes) and intraoperative blood loss (64 versus 57 mL) were not different between the two groups. None of 560 patients had a wound infection requiring surgical intervention. The rate of postoperative hematoma was 0.7% in the group that received drains (two of 298 patients) and 0% in the group that did not receive drains (zero of 262 patients).


CONCLUSIONS
In this study, the risk of wound infection and hematomas in single-level lumbar decompression surgery was not influenced by use of a drain. The use of postoperative wound drainage in patients with potential risk for epidural bleeding in situations such as multiple-level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases needs additional study.


METHODS
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Kanayama
Masahiro
M
Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan. mkanayama@aol.com
Oha
Fumihiro
F
Togawa
Daisuke
D
Shigenobu
Keiichi
K
Hashimoto
Tomoyuki
T
D000328:Adult; D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D019299:Decompression, Surgical / Q000009:adverse effects; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007564:Japan; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013396:Suction / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome