title: The Use of Closed Suction Drainage in Lumbar Spinal Surgery: Is It Really Necessary?
abstract: BACKGROUND
  Closed wound suction drainage after spine surgery is commonly used in clinical practice. However, no consensus has been reached for using drainage versus nondrainage after lumbar spinal surgery until now.
  
  
  OBJECTIVE
  The purpose of this study was to determine the clinical outcomes of using closed suction drainage versus nondrainage after lumbar spinal surgery.
  
  
  METHODS
  We conducted a systematic review and meta-analysis to identify relevant studies from PubMed, MEDLINE, EMBASE, Cochrane Library, and Google scholar up to September 2015. All randomized, quasi-randomized, and controlled clinical studies, which compared the clinical outcomes of using closed suction drainage versus nondrainage in patients who underwent lumbar spinal surgery, were included. Data extraction and quality assessment were according to Cochrane Collaboration guidelines.
  
  
  RESULTS
  Five studies involving 1295 patients were included in this meta-analysis. By pooling the clinical outcomes, there were no significant differences between patients with drainage and nondrainage in terms of the incidence of wound infection (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.47-4.71; P = 0.50), wound hematoma (OR, 0.45; 95% CI, 0.01-29.31, P = 0.71), and reoperation (OR, 1.36; 95% CI, 0.22-8.27; P = 0.74). Drainage after lumbar surgery was associated with more blood loss and significantly greater blood transfusions (OR, 3.68; 95% CI, 1.80-7.54; P < 0.01) compared with nondrainage. However, more patients contracted postoperative fever in the nondrainage group than did those in drainage group.
  
  
  CONCLUSIONS
  Based on this systematic review and meta-analysis, there is insufficient evidence to suggest routine use of prophylactic closed suction drainage after lumbar spinal surgery. However, a decision to use or not use drainage should be individualized for each patient because many factors affect the outcomes.
authors.affiliation: Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Wen-Zhao
authors.initials: WZ
authors.lastname: Chen
authors.affiliation: Department of Rheumatology and Immunology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Bi-Qi
authors.initials: BQ
authors.lastname: Fu
authors.affiliation: Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Jiang-Wei
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China. Electronic address: liuzhiliyfy@163.com.
authors.forename: Zhi-Li
authors.initials: ZL
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.
authors.forename: Shan-Hu
authors.initials: SH
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013396:Suction / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Closed suction drainage; Lumbar spine; Meta-analysis; Wound