title: When should axillary drains be removed? A meta-analysis of time-limited versus volume controlled strategies for timing of drain removal following axillary lymphadenectomy.
abstract: BACKGROUND
  Despite numerous studies over the past few decades, the optimum strategy for deciding when to remove drains following axillary lymphadenectomy remains unknown. This meta-analysis aims to compare time-limited and volume-controlled strategies for drain removal.
  
  
  METHODS
  A total of 584 titles were identified following a systematic literature search of EMBASE, MEDLINE, Cinahl and the Cochrane library; 6 titles met our eligibility criteria. Data were extracted and independently verified by two authors. Time-limited drain removal was defined as drain removal at <5 days; volume-controlled strategies ranged from <20 ml/24 h to <50 ml/24 h.
  
  
  RESULTS
  In all the studies, the time-limited approach resulted in earlier drain removal. Development of a seroma is 2.54 times more likely with early drain removal (Mantel-Haenszel Fixed Odds Ratio (OR) 2.54, p < 0.00001). However, there is no difference in infection rates between early and late drain removal (OR = 1.07, p = 0.76).
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that a strategy of early drain removal following axillary lymphadenectomy is safe, with no difference in infection rates; however, the incidence of seroma is significantly higher, which may necessitate more demanding outpatient care. There is a need for further well-designed clinical trials to address the clinical equipoise in this common area of surgical practice.
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK. Electronic address: davidthomson134@gmail.com.
authors: David R
authors: DR
authors: Thomson
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK.
authors: Alexander E J
authors: AE
authors: Trevatt
authors: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
authors: Dominic
authors: D
authors: Furniss
mesh_terms: D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D020878:Device Removal / Q000009:adverse effects / Q000379:methods; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis; D049291:Seroma / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D061665:Time-to-Treatment
keywords: Axilla; Drain; Lymphadenectomy; Removal; Timing