Closed Suction Drainage Has No Benefits in Anterior Hip Arthroplasty: A Prospective, Randomized Trial

• Published in: The Journal of arthroplasty 2016-09, Vol.31 (9), p.1954-1958
• Main Authors: Suarez, Juan C., MD, McNamara, Colin A., BS, Barksdale, Leticia C., MD, Calvo, Cecilia, Szubski, Caleb R., BS, Patel, Preetesh D., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antifibrinolytic Agents - therapeutic use; Arthroplasty, Replacement, Hip - methods; Aspirin - therapeutic use; blood loss; Blood Loss, Surgical - prevention & control; Blood Loss, Surgical - statistics & numerical data; Blood Transfusion - statistics & numerical data; closed suction drain; direct anterior total hip arthroplasty; drain; Drainage - methods; Female; Fibrinolytic Agents - therapeutic use; Hematoma; Hemoglobins - analysis; Hemostasis, Surgical; Humans; Length of Stay; Male; Middle Aged; Orthopedics; Prospective Studies; Suction; total hip arthroplasty; Tranexamic Acid - therapeutic use; Venous Thromboembolism - prevention & control
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.02.048

Abstract Background Many studies have challenged routine drain placement in patients undergoing total hip arthroplasty. Some studies suggest increased transfusion rate with the use of closed suction drains. The use of tranexamic acid to control surgical bleeding and aspirin for venous thromboembolism prophylaxis has gained popularity. No study has evaluated the use of drains in patients undergoing direct anterior total hip arthroplasty under these conditions. Methods We performed a prospective, randomized study in patients undergoing direct anterior total hip arthroplasty to evaluate whether closed suction drain placement provides any clinical benefit. Patients randomly assigned to the control group had closed suctions drains placed; patients randomly assigned to the treatment group had no drains placed. The primary outcome measures were hematoma formation, wound complications, and transfusion rates. The secondary outcome measures were estimated blood loss, decrease in hemoglobin and hematocrit levels, total hemoglobin loss, calculated blood loss, hidden blood loss, and total length of hospital stay. Differences in outcomes between groups were considered to be significant at P ≤ .05. Results There were no significant differences between groups in transfusion rate ( P  = .49), postoperative decrease in hemoglobin levels ( P  = .95), average calculated blood loss ( P  = .65), complications ( P  = .49), or length of hospital stay ( P  = .14). There was no hematoma formation observed in either group. Conclusion Our study showed no clinical benefit or disadvantage to closed suction drainage in anterior hip arthroplasty with the concomitant use of tranexamic acid for surgical hemostasis and aspirin for venous thromboembolism prophylaxis.