295 - Effectiveness of Postoperative Wound Drains in One- and Two-level Cerv...

#295 Effectiveness of Postoperative Wound Drains in One- and Two-level Cervical Spine Fusion

Cervical Therapies and Outcomes

Poster Presented by: A.J. Boniello

Author(s):

C.E. Poorman (1)
P.G. Passias (1)
K.M. Bianco (1)
A.J. Boniello (1)
S.Y. Yang (1)
M.C. Gerling (1)

(1) NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, NY, United States

Abstract

Introduction: This study examines the effectiveness of postoperative cervical drains for patients undergoing one- and two-level cervical fusions. Cervical drains have historically been used to avoid postoperative wound and respiratory complications such as excessive edema, hematoma, infection, re-intubation, delayed extubation, or respiratory distress. Recently, some surgeons have ceased using drains because they may prolong hospital stay, operative time, or patient discomfort. This study compares patients treated without cervical drains versus patients treated with drains.

Methods: A retrospective chart review was conducted on patients who received one- and two- level cervical spine fusion at a single institution between 2010 and 2013. The analysis compared patients who received a post-operative drain to those who did not. Demographic measures such as age, sex, height, weight, BMI, and number of levels of fusion were recorded. Outcome measures included length of surgery, length of hospital stay, estimated blood loss (EBL) and incidence of intraoperative and perioperative complications as reported by hospital inpatient charts. Wound complications were defined as infection, hematoma, edema, and complications with wound healing or evacuation. Respiratory complications were defined as delayed extubation, re-intubation, and respiratory treatment. Overall complications included wound complications, respiratory complications, dysphagia, and other events that prolonged hospital stay. Statistical analyses were performed using independent samples t-test, chi-square, and linear regression.

Results: The study population included 84 patients: 41 patients who received a postoperative drain and 43 patients who did not (Table 1). There were no significant differences in demographics between the two groups. Patients with drains had significantly longer operative time (104.8 vs. 70.4 min, p< 0.001) and a significantly longer length of hospital stay (44.2 vs. 31.8 hrs, p< 0.01) than patients without drains. Patients with drains also had a significantly higher EBL than patients without drains (73.0 vs. 30.7 mL, p< 0.01). Linear regression analysis controlling for number of levels fused, age, and BMI confirmed that length of surgery and length of hospital stay were correlated with the presence of a surgical drain (p< 0.001, p< 0.01, respectively). Furthermore, length of hospital stay was correlated with age of patients (p< 0.01). The frequency of wound complications, respiratory complications, and overall complications did not significantly vary between groups.

Discussion and Conclusion: Our results suggest that cervical drains may not be necessary for patients undergoing one- and two-level cervical fusion. While there were no differences in incidence of complications between the two groups in this study, the patients treated with postoperative drains had significantly longer hospital stays and operative times. This could contribute to excessive costs for patients who are treated with drains, despite the lack of compelling evidence of the advantages of this treatment, both in the literature and in the current study.

Table 1