title: Systematic review and meta-analysis of wound drains after thyroid surgery.
abstract: BACKGROUND
  Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
  
  
  METHODS
  A systematic review and meta-analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.
  
  
  RESULTS
  Twenty-five RCTs were included in the meta-analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound-assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. -0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units).
  
  
  CONCLUSIONS
  The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
authors.affiliation: Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: R S R
authors.initials: RS
authors.lastname: Woods
authors.forename: J F C
authors.initials: JF
authors.lastname: Woods
authors.forename: E S
authors.initials: ES
authors.lastname: Duignan
authors.forename: C
authors.initials: C
authors.lastname: Timon
mesh_terms: D004322:Drainage / Q000379:methods; D006801:Humans; D007902:Length of Stay; D010279:Parathyroid Diseases / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D013396:Suction / Q000379:methods; D013959:Thyroid Diseases / Q000601:surgery*; D016896:Treatment Outcome