Wound drains following thyroid surgery

• Published in: Cochrane database of systematic reviews 2007-10, Vol.2007 (4), p.CD006099-CD006099
• Main Authors: Samraj, K, Gurusamy, K S
• Format: Article
• Language: English
• Subjects: Drainage - adverse effects; Drainage - instrumentation; Hematoma - prevention & control; Humans; Length of Stay; Pain, Postoperative - etiology; Postoperative Hemorrhage - therapy; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome - etiology; Seroma - prevention & control; Surgical Wound Infection - etiology; SURGICAL WOUNDS; Thyroid Diseases - surgery; Thyroidectomy - adverse effects; Thyroidectomy - methods; Wounds
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD006099.pub2

The nature and indications for thyroid surgery vary and a perceived risk of haemorrhage post-surgery is one reason why wound drains are frequently inserted. However when a significant bleed occurs, wound drains may become blocked and the drain does not obviate the need for surgery or meticulous haemostasis. The evidence in support of the use of drains post-thyroid surgery is unclear therefore and a systematic review of the best available evidence was undertaken. To determine the effects of inserting a wound drain during thyroid surgery, on wound complications, respiratory complications and mortality. We searched the following databases: Cochrane Wounds Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 1, 2007); MEDLINE (2005 to February 2007); EMBASE (2005 to February 2007); CINAHL (2005 to February 2007) using relevant search strategies. Only randomised controlled trials were eligible for inclusion. Quasi randomised studies were excluded. Studies with participants undergoing any form of thyroid surgery, irrespective of indications, were eligible for inclusion in this review. Studies involving people undergoing parathyroid surgery and lateral neck dissections were excluded. At least 80% follow up (till discharge) was considered essential. Studies were assessed for eligibility and data were extracted by two authors independently, differences were resolved by discussion. Studies were assessed for validity including criteria on whether they used a robust method of random sequence generation and allocation concealment. Missing and unclear data were resolved by contacting the study authors. 13 eligible studies were identified (1646 participants). 11 studies compared drainage with no drainage and found no significant difference in re-operation rates; incidence of respiratory distress and wound infections. Post-operative wound collections needing aspiration or drainage were significantly reduced by drains (RR 0.51, 95% CI 0.27 to 0.97), but a further analysis of the 4 high quality studies showed no significant difference (RR 1.82, 95% CI 0.51 to 6.46). Hospital stay was significantly prolonged in the drain group (WMD 1.18 days, 95% CI 0.73 to 1.63).Eleven studies compared suction drain with no drainage and found no significant difference in re-operation rates; incidence of respiratory distress and wound infection rates. The incidence of collections that required aspiration or drainage without formal re-operation wa