Article Abstract

The use of subfascial drains after multi-level anterior cervical discectomy and fusion: does the data support its use?

Authors: Owoicho Adogwa, Syed I. Khalid, Aladine A. Elsamadicy, Victoria D. Voung, Daniel T. Lilly, Shyam A. Desai, Amanda R. Sergesketter, Joseph Cheng, Isaac O. Karikari

Abstract

Background: Subfascial drains are routinely used after multi-level anterior cervical discectomy and fusion (ACDF) procedures despite little evidence to support their use. Proponents of drain use argue that drain placement reduces the incidence of post-operative hematomas and surgical site infections (SSI). The aim of this study is to determine whether the use of subfascial drains after multi-level ACDFs are associated with a decreased incidence of hematomas and SSIs.
Methods: This is a retrospective study of 321 consecutive adult patients (18 years and older) with degenerative cervical stenosis that undergoing an index multi-level ACDF procedure. Only patients undergoing multilevel ACDF were included in the study. Patients were separated into one of two groups depending whether a subfascial drain was placed during surgery. The decision to place a drain was based on surgeon preference. Baseline characteristics, operative details, as well as rates of hematoma formation and SSIs were gathered by direct medical record review.
Results: Of the 321 patients enrolled in the study, 58 (18%) patients had subfascial drains placed at the time of surgery. Baseline demographics and co-morbidities were similar between both cohorts; however, on average, patients in the “Drain Use” cohort were older when compared to those in the “No Drain” cohort (64 vs. 56 years old, P<0.0001). There was no observed difference between both groups in the incidence of post-operative hematoma formation (P=0.99) or SSI (P=0.99). Five percent of patients in the “Drain Use” cohort required a post-operative allogenic blood transfusion compared to less than 1% (0.4%) in the comparison cohort. The duration of hospital stay was almost 2-fold longer in the in the “Drain use” cohort compared to the comparison cohort (“Drain Use”: 2.82 days vs. “No Drain”: 1.58 days, P<0.0001).
Conclusions: The use of subfascial drains after multi-level ACDF procedures were not associated with a decreased incidence of hematoma formation or SSIs. In fact, patients in which a subfascial drain was used were 14 times more likely to require a post-operative blood transfusion and with an almost 2-fold increase in the duration of in-hospital stay.