title: Avoiding drainage after major hip surgery in children is a viable option: results from a retrospective comparative study.
abstract: OBJECTIVE
  The use of closed-suction drainage systems to evacuate haematomas after surgical procedures is still common practice in many orthopaedic departments. However, no evidence to support the routine use of closed-suction drains in orthopaedic surgery exists. Post-operative handling and removal of the drain is particularly complicated in children. We hypothesised that the use of surgical drains in major hip procedures in children does not reduce the complication rate.
  
  
  METHODS
  The records of 63 children undergoing 97 major hip procedures managed with closed-suction drains (centre A), and 75 children undergoing 130 major hip procedures without application of wound drains (centre B) were retrospectively reviewed in this dual-centre study. Demographic data, pre-existing conditions, surgical indications and procedures, duration of hospitalisation and complication rates were analysed.
  
  
  RESULTS
  Children (mean age, 8.3 ± 4 years) in both groups presented similar demographics, medical histories, surgical indications and procedures. No intra-operative complications occurred in either group. In the undrained group a significant shorter hospitalisation time was observed. Overall, there were 31 complications (31.9 %) in the drained group and 26 complications (20 %) in undrained group (p = 0.05). Applying the Clavien-Dindo grading system, both groups had mainly minor grade I and grade II complications. No differences regarding the rate of wound-related complications were observed between the two groups.
  
  
  CONCLUSIONS
  The use of wound drains in our study cohorts has been shown to have no positive impact on complications rates after corrective osteotomies around the hip joint in children. In the light of our results and of the poor evidence of drainage use in adults, we do not recommend the routine use of drains in children undergoing orthopaedic hip procedures.
authors.affiliation: Centre for Musculoskeletal Surgery, Department of Paediatric Orthopaedic Surgery, Campus Virchow, Charité-University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. claudia.druschel@charite.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Druschel
authors.affiliation: Clinic for Orthopaedics and Trauma Surgery, Department of Paediatric Orthopedic Surgery, University Hospital Bonn, 53127, Bonn, Germany.
authors.forename: Katherina
authors.initials: K
authors.lastname: Heck
authors.affiliation: Clinic for Orthopaedics and Trauma Surgery, Department of Paediatric Orthopedic Surgery, University Hospital Bonn, 53127, Bonn, Germany.
authors.forename: Peter Heinrich
authors.initials: PH
authors.lastname: Pennekamp
authors.affiliation: Clinic for Orthopaedics and Trauma Surgery, Department of Paediatric Orthopedic Surgery, University Hospital Bonn, 53127, Bonn, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wimmer
authors.affiliation: Centre for Musculoskeletal Surgery, Department of Paediatric Orthopaedic Surgery, Campus Virchow, Charité-University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Julia Franziska
authors.initials: JF
authors.lastname: Funk
authors.affiliation: Clinic for Orthopaedics and Trauma Surgery, Department of Paediatric Orthopedic Surgery, University Hospital Bonn, 53127, Bonn, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Placzek
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
keywords: Drainage; Hip surgery; Paediatric orthopaedics