title: The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial.
abstract: BACKGROUND
  Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.
  
  
  METHODS
  We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n = 49) or a no-drain group (n = 44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications.
  
  
  RESULTS
  There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value = 0.005), and day 2, 18.4 versus 25.7 ml (P-value = 0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P = 0.154). No life-threatening bleeds occurred in either group.
  
  
  CONCLUSIONS
  Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains.
  
  
  BACKGROUND
  ISRCTN94715414.
authors.affiliation: Department of Academic Surgery, Cork University Hospital, University College Cork, Cork, Ireland. peterneary@hotmail.com
authors.forename: Peter M
authors.initials: PM
authors.lastname: Neary
authors.forename: Owen J
authors.initials: OJ
authors.lastname: O'Connor
authors.forename: Azher
authors.initials: A
authors.lastname: Shafiq
authors.forename: Edel M
authors.initials: EM
authors.lastname: Quinn
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: Buckley
authors.initials: B
authors.lastname: Juliette
authors.forename: Ronan A
authors.initials: RA
authors.lastname: Cahill
authors.forename: Josephine
authors.initials: J
authors.lastname: Barry
authors.forename: Henry P
authors.initials: HP
authors.lastname: Redmond
mesh_terms: D000293:Adolescent; D000328:Adult; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000209:etiology; D050031:Hashimoto Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D013997:Time Factors; D014465:Ultrasonics; D055815:Young Adult