Role of postoperative wound drains in spinal surgery

Introduction There is no unified opinion on the use of drains and their indication in spinal surgery. The main discussion focuses on the issue of infection rate reduction and its prophylaxis. It is believed that drains increase postoperative morbidity: infectious complications, anemia, and indications to blood transfusion. Material and methods One hundred and fifty patients that underwent surgical interventions on the spine from the posterior surgical approach were included into this study. According to surgical invasiveness, patients were divided in groups. Group 1 was 29 persons with lumbar disc hernias. Group 2 were 85 patients with degenerative dystrophic diseases and posttraumatic deformities of the lumbar spine in one to three spine motor segments. Group 3 were 37 patients that had multilevel spinal deformities. Drains were not used in group 1 due to low invasiveness of the operation. Patients of groups 2 and 3 were divided into subgroups in which active drains were used or not used. Parameters for analysis were age, weight, duration of surgery, blood loss, length and deepness of wounds, duration of draining, amount of wound discharge, number of wound punctures and punctuate volume, duration of inpatient stay, associated diseases (arterial hypertension, diabetes, obesity and other chronic diseases in the remission stage), presence of infection complications in the postoperative period (superficial or deep), conduction of blood transfusion, neurologic deficits due to epidural hematoma. Method of variation statistics was used: calculation of mean (M) and its error (± m), r-Pierson correlation coefficient according to Chaddock scale; significance of statistical difference was assessed with Student’s t-test. Results and discussion Most studies that assess the efficiency of using drains show no difference in wound healing, infectious complication rates and epidural hematomas in spinal surgery. Different requirements are defined to wound drains according to volume, duration, techniques and instrumentation used in surgery. Discotomies and interventions of decompression stabilization at one to three levels do not require wound drains. Conclusion Treatment results and complication rate do not depend upon surgical wound drains. Draining used in multilevel stabilization operations on the thoracic and lumbar spine with the variants of vertebrotomies increases the frequency of hemotransfusion in the postoperative period and inpatient stay.