Systematic review and meta-analysis of wound drains after thyroid surgery
Background Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains. Methods A systematic review and meta‐analysis was performed according to PRI...
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| Veröffentlicht in: | British journal of surgery 2014-04, Vol.101 (5), p.446-456 |
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| creator | Woods, R. S. R. Woods, J. F. C. Duignan, E. S. Timon, C. |
| description | Background
Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
Methods
A systematic review and meta‐analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.
Results
Twenty‐five RCTs were included in the meta‐analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound‐assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. –0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units).
Conclusion
The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
The use of drains is obsolete |
| doi_str_mv | 10.1002/bjs.9448 |
| format | Article |
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Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
Methods
A systematic review and meta‐analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.
Results
Twenty‐five RCTs were included in the meta‐analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound‐assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. –0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units).
Conclusion
The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
The use of drains is obsolete</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.9448</identifier><identifier>PMID: 24633830</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Drainage - methods ; Humans ; Length of Stay ; Parathyroid Diseases - surgery ; Postoperative Care - methods ; Publication Bias ; Randomized Controlled Trials as Topic ; Suction - methods ; Thyroid Diseases - surgery ; Treatment Outcome</subject><ispartof>British journal of surgery, 2014-04, Vol.101 (5), p.446-456</ispartof><rights>2014 BJS Society Ltd. Published by John Wiley & Sons Ltd</rights><rights>2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-e0c8f51c29d8dd3b300ca6f3828874ba0fe45fee441109247956a66d3ccc6c0f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.9448$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.9448$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24633830$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Woods, R. S. R.</creatorcontrib><creatorcontrib>Woods, J. F. C.</creatorcontrib><creatorcontrib>Duignan, E. S.</creatorcontrib><creatorcontrib>Timon, C.</creatorcontrib><title>Systematic review and meta-analysis of wound drains after thyroid surgery</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
Methods
A systematic review and meta‐analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.
Results
Twenty‐five RCTs were included in the meta‐analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound‐assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. –0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units).
Conclusion
The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
The use of drains is obsolete</description><subject>Drainage - methods</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Parathyroid Diseases - surgery</subject><subject>Postoperative Care - methods</subject><subject>Publication Bias</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Suction - methods</subject><subject>Thyroid Diseases - surgery</subject><subject>Treatment Outcome</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0E1LxDAQgOEgiq6r4C-Qghcv1UkmTdOj364sKqwieAnZNNWs7VaT1rX_3i5-gaeBzENgXkJ2KBxQAHY4nYWDjHO5QgYURRIzKuQqGQBAGlNkuEE2Q5gBUISErZMNxgWiRBiQ0aQLja1040zk7buzi0jP86iyjY71XJddcCGqi2hRt_1z7rWbh0gXjfVR89z52uVRaP2T9d0WWSt0Gez29xyS-_Ozu5PLeHxzMTo5GscGpZSxBSOLhBqW5TLPcYoARosCJZMy5VMNheVJYS3nlELGeJolQguRozFGGChwSPa__n319VtrQ6MqF4wtSz23dRsUTUByRlOe9nTvH53Vre-v6lWaoGCZkEu1-63aaWVz9epdpX2nfiL1IP4CC1fa7ndPQS3jqz6-WsZXx1eT5fzzrk_78eu1f1EixTRRD9cXanz6OHl4vLxViJ-HPITL</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Woods, R. S. R.</creator><creator>Woods, J. F. C.</creator><creator>Duignan, E. S.</creator><creator>Timon, C.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>Systematic review and meta-analysis of wound drains after thyroid surgery</title><author>Woods, R. S. R. ; Woods, J. F. C. ; Duignan, E. S. ; Timon, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-e0c8f51c29d8dd3b300ca6f3828874ba0fe45fee441109247956a66d3ccc6c0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Drainage - methods</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Parathyroid Diseases - surgery</topic><topic>Postoperative Care - methods</topic><topic>Publication Bias</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Suction - methods</topic><topic>Thyroid Diseases - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Woods, R. S. R.</creatorcontrib><creatorcontrib>Woods, J. F. C.</creatorcontrib><creatorcontrib>Duignan, E. S.</creatorcontrib><creatorcontrib>Timon, C.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Woods, R. S. R.</au><au>Woods, J. F. C.</au><au>Duignan, E. S.</au><au>Timon, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review and meta-analysis of wound drains after thyroid surgery</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2014-04</date><risdate>2014</risdate><volume>101</volume><issue>5</issue><spage>446</spage><epage>456</epage><pages>446-456</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
Methods
A systematic review and meta‐analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed.
Results
Twenty‐five RCTs were included in the meta‐analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 1·90, 95 per cent c.i. 0·87 to 4·14), ultrasound‐assessed fluid volume on day 1 after surgery (MD 2·30 (95 per cent c.i. –0·73 to 5·34) ml), wound collection requiring intervention (RR 0·64, 0·38 to 1·09) or not (RR 0·93, 0·66 to 1·30), transient voice change (RR 2·33, 0·91 to 5·96) and persistent recurrent laryngeal nerve palsy (RR 1·67, 0·22 to 12·51). Length of hospital stay was significantly greater in the drain group (MD 1·25 (0·83 to 1·68) days), as were wound infection rates (RR 2·53, 1·23 to 5·21) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 1·46 (0·67 to 2·26) units).
Conclusion
The results indicate that drain use after routine thyroid surgery does not confer a benefit to patients.
The use of drains is obsolete</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>24633830</pmid><doi>10.1002/bjs.9448</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Drainage - methods Humans Length of Stay Parathyroid Diseases - surgery Postoperative Care - methods Publication Bias Randomized Controlled Trials as Topic Suction - methods Thyroid Diseases - surgery Treatment Outcome |
| title | Systematic review and meta-analysis of wound drains after thyroid surgery |
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