Use and outcomes of wound drain in spinal fusion for adolescent idiopathic scoliosis.
METHODS
A multicenter retrospective analysis.


OBJECTIVE
To evaluate outcomes of closed-suction wound drainage after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis and to identify surgeon patterns of drain use in this cohort.


BACKGROUND
There is little evidence on the use of drains in spinal surgery, particularly for repair of adolescent idiopathic scoliosis. Studies on hip and knee arthroplasty suggest no advantage to draining. There are few published reports on surgeon technique and rationale for drain use in spinal surgery.


METHODS
Patients were divided into drain and no drain cohorts and followed for 2 years. Primary outcome was complication rate. A separate survey was conducted from surgeons in the Spinal Deformity Study Group to evaluate drain practice patterns.


RESULTS
There were 324 drained and 176 undrained patients. Complication rate did not differ between the drain and no drain cohorts in any of the 4 categories (wound infection, neural injury, other infection, and other complication) at any time (all P > 0.1). More drained patients received postoperative transfusions compared with those without a drain (43% vs. 22%, P < 0.001). Of the 50 surgeons in the group, 36 used drains. Half of these did so out of habit. Surgeons tended to place deep drains with bulb suction, without drain manipulation. Half removed drains on the basis of output, whereas half removed them after 1 to 3 days.


CONCLUSIONS
More patients tended to receive wound drains than not receive wound drains. Drains did not impact complication rate and drained patients received more blood product. There are no universal criteria for draining and practice patterns vary widely.
Department of Orthopaedic Surgery, University of California, San Francisco Medical Center, San Francisco, CA 94143, USA. diab@orthosurg.ucsf.edu
Mohammad
M
Diab
Mia
M
Smucny
John P
JP
Dormans
Mark A
MA
Erickson
Kamal
K
Ibrahim
Lawrence G
LG
Lenke
Daniel J
DJ
Sucato
James O
JO
Sanders
D000293:Adolescent; D003131:Combined Modality Therapy; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013530:Surgical Wound Infection / Q000209:etiology