Final 24-hour Drain Output and Post-Operative Day are Poor Indicators for Appropriate Drain Removal
Charleston Chua,MD1, Corey Bascone, MD1, Clifford Pereira, MD1 1University of California, Davis, Sacramento, CA
Background: Closed suction drainage is commonly used in plastic surgical procedures to remove excess fluid and facilitate tissue apposition. These actions are thought to ameliorate complications such as seromas or wound dehiscence. A review of the literature demonstrates a paucity of evidence supporting any guiding parameters on when to appropriately discontinue closed suction drainage from a surgical site. The aim of our study is to determine whether two of the most common parameters, i.e. drain volume 24 hours prior to removal or post-operative day, are valid indicators for drain removal.
Methods: An institutional review board approved retrospective chart review was conducted for all surgical operations performed by our division between July 1, 2014 to May 14, 2019. Of 1308 patients, 710 left the operating room with a closed suction drain (43.2% cosmetic, 56.8% reconstructive). 616 patients had complete records. Demographic data, pertinent medical history, operative time, antibiotic use, anatomic site of surgery, donor/recipient, and type of complication were recorded. Complications were defined as events which deviated from the expected post-operative course or required pharmacological/procedural intervention after removal of all closed suction drains. Student t-test was used to compare continuous data and normal distribution while the Chi square test was used to analyze nominal data.
Results: Review of the first 90 days after the operation revealed 544 patients in the no complication group (NCG) while 72 patients were in the complication group (CG). Patients in the CG had their drains removed later than patients in the NCG (15.7 days versus 12.5 days, p = 0.0003). Patients in the CG had similar final 24 hour drain volumes than patients in the NCG (16.7mL versus 18.8mL, p = 0.2548). There were no differences found between the groups in terms of patient age (51.1 vs. 51.8; p = 0.68), BMI (28.4 vs. 27.4; p = 0.13), ASA class (2.44 vs. 2.38; p = 0.41), medical history, operative time (4h1m vs. 3h34m; p = 0.14), antibiotic use (51.4% vs. 56.3%; p = 0.98), antibiotic length (13.8 days vs. 11.9%; p = 0.33), extirpated specimen weight (1107.8g vs. 1036.9g; p = 0.67), complication at donor (10% vs. 10.8%; p = 0.85) or recipient (16.3% vs. 10.3%; p = 0.15) site. The CG had more males (25% vs. 14.9%; p = 0.028) and patients who had an operation on the pelvis (11% vs. 2.1%; p = 0.000017) or thigh (8.5% vs. 3.4%; p = 0.029).
Conclusion: This data suggests neither the use of post-operative day nor the use of 24 hour volume prior to drain removal are valid indicators for drain removal. Drain removal 3 days later correlates with more complications, however, the persisting output leading to the later removal may be predictive of an impending complication rather than a delay in drain removal causing the complication. Further study on factors independent of the practitioner's objective data, such as patient compliance with drain care and adherence to activity restrictions, should be conducted to further elucidate the root cause of these complications despite drain use.
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