title: The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: A Systematic Review.
abstract: Study Design Systematic review. Objective Determine whether closed suction wound drains decrease the incidence of postoperative complications compared with no drain use in patients undergoing spine surgery for lumbar degenerative conditions. Methods Electronic databases and reference lists of key articles were searched up through January 22, 2015, to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection, and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group. Results Five heterogeneous studies, three randomized controlled trials, and two cohort studies form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with compared with patients without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered low or insufficient. Conclusions Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on closed suction wound drains in lumbar spine surgery until a higher level of evidence becomes available to support its use.
authors.affiliation: McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada ; Department of Orthopedic Surgery, University of Tabuk, Tabuk, Saudi Arabia.
authors.forename: Feras
authors.initials: F
authors.lastname: Waly
authors.affiliation: McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada ; Department of Orthopedic Surgery, University of Dammam, Al-Dammam, Saudi Arabia.
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Alzahrani
authors.affiliation: McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada ; Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Fahad H
authors.initials: FH
authors.lastname: Abduljabbar
authors.affiliation: McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Landry
authors.affiliation: McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Ouellet
authors.affiliation: Spectrum Research, Inc., Tacoma, Washington, United States.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Moran
authors.affiliation: Spectrum Research, Inc., Tacoma, Washington, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Dettori
keywords: closed suction drains; hematoma; infection; lumbar spine surgery; postoperative complications; spinal drains; wound drain