A systematic review and meta-analysis of wound drains in non-instrumented lumbar decompression surgery

Christopher L. Davidoff, Jeffrey Rogers, Mary Simons, Andrew Davidson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Wound drains are routinely used in lumbar decompressive surgery (LDS). However, it remains unclear whether this practice helps to prevent symptomatic epidural hematoma formation and associated complications, particularly following non-instrumented procedures. A systematic review and meta-analysis was therefore completed to critically appraise the literature. The search protocol was conducted using the Ovid MEDLINE, EMBASE, Scopus, Cochrane Library, and Google Scholar databases. Articles meeting the following criteria were included: (i) examined patients undergoing LDS; (ii) included cases receiving post-operative wound drains; (iii) detailed adverse outcomes including symptomatic epidural hematomas or wound infection; and (iv) were published in English in a peer-reviewed journal. Pooled risk differences (RD) for adverse outcomes were calculated using Comprehensive Meta-Analysis software. Three Level 1b prospective randomized studies and five Level 2b retrospective cohort studies were included, from which 5,327 cases were identified as having received a surgical drain and 773 were identified as having received no drainage following non-instrumented LDS. There was no difference between groups in the risk of symptomatic epidural hematoma (RD = 0.02; 95% CI -0.02 - 0.06, p = 0.28) or post-operative infection (RD = 0.00; 95% CI -0.01 - 0.01, p = 0.91). In conclusion, symptomatic epidural hematomas and infection are rare following non-instrumented LDS, with incidence rates unaffected by the routine use of wound drainage.
LanguageEnglish
Pages55-61
Number of pages7
JournalJournal of Clinical Neuroscience
Volume53
Early online date19 Apr 2018
DOIs
Publication statusPublished - Jul 2018

Fingerprint

Decompression
Hematoma
Meta-Analysis
Wounds and Injuries
Drainage
Wound Infection
Infection
MEDLINE
Libraries
Cohort Studies
Software
Retrospective Studies
Databases
Prospective Studies
Incidence

Keywords

  • Epidural hematoma
  • Laminectomy
  • Microdiscectomy
  • Systematic review
  • Wound drain

Cite this

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abstract = "Wound drains are routinely used in lumbar decompressive surgery (LDS). However, it remains unclear whether this practice helps to prevent symptomatic epidural hematoma formation and associated complications, particularly following non-instrumented procedures. A systematic review and meta-analysis was therefore completed to critically appraise the literature. The search protocol was conducted using the Ovid MEDLINE, EMBASE, Scopus, Cochrane Library, and Google Scholar databases. Articles meeting the following criteria were included: (i) examined patients undergoing LDS; (ii) included cases receiving post-operative wound drains; (iii) detailed adverse outcomes including symptomatic epidural hematomas or wound infection; and (iv) were published in English in a peer-reviewed journal. Pooled risk differences (RD) for adverse outcomes were calculated using Comprehensive Meta-Analysis software. Three Level 1b prospective randomized studies and five Level 2b retrospective cohort studies were included, from which 5,327 cases were identified as having received a surgical drain and 773 were identified as having received no drainage following non-instrumented LDS. There was no difference between groups in the risk of symptomatic epidural hematoma (RD = 0.02; 95{\%} CI -0.02 - 0.06, p = 0.28) or post-operative infection (RD = 0.00; 95{\%} CI -0.01 - 0.01, p = 0.91). In conclusion, symptomatic epidural hematomas and infection are rare following non-instrumented LDS, with incidence rates unaffected by the routine use of wound drainage.",
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A systematic review and meta-analysis of wound drains in non-instrumented lumbar decompression surgery. / Davidoff, Christopher L.; Rogers, Jeffrey; Simons, Mary; Davidson, Andrew.

In: Journal of Clinical Neuroscience, Vol. 53, 07.2018, p. 55-61.

Research output: Contribution to journalArticleResearchpeer-review

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