The application of drains in thyroid surgery

Abstract

It has been shown that the use of drain in thyroid surgery does not reduce the reoperation rate for hemorrhage. The aim of this systematic review was to update the knowledge of the role of drain in thyroid surgery in term of postoperative complications, pain and hospital length of stay (LOS). A systematic search was performed in the PubMed and Embase database to identify all randomized controlled trials (RCTs) comparing clinical outcomes in patients who underwent thyroidectomy or lobectomy with or without drainage. The primary outcome was reoperation rate for bleeding; the secondary outcomes were development of hematoma, seroma, and wound infection; postoperative pain evaluated by Visual Analogue Scale (VAS) at the postoperative day (POD) 1, and hospital LOS. Risk ratios (RRs) and 95% confident intervals (95% CI) were used for dichotomous variables; mean differences (MDs) and 95% CI for continuous variables. Statistical heterogeneity was evaluated and its degree was quantified by the I2 statistic. Twenty RCTs were included, with 2,204 patients enrolled. No difference was found between the two groups in term of reoperation [RR 1.13 (0.43, 2.95); I2 =0%], hematoma [RR 1.18 (0.71, 1.95); I2 =0%], and seroma [RR 0.82 (0.44, 1.53); I2 =0%]. Patients with drain had higher postoperative pain [MD 1.91 (1.30, 2.53); I2 =97%], prolonged hospital LOS [MD 1.34 (0.91, 1.76) days; I2 =98%], and increased wound infection rate [RR 2.82 (1.36, 5.86); I2 =0%], even though the latter was not confirmed in the sensitivity analysis including only studies with ≥100 patients per trial. The use of drain after thyroid surgery increase postoperative pain and hospital LOS, with no decrease of reoperation rate, hematoma and seroma formation. An increased wound infection rate in patients with drain is suggested, but a large RCT should be performed to confirm this correlation.

Keywords: Drainage; meta-analysis; postoperative complications; randomized controlled trial (RCT); thyroidectomy.

Figure 1

Flow chart illustrating the systematic search and the selection process of the articles.

Figure 2

Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 3

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

Figure 4

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: reoperation for bleeding. Mantel-Haenszel (M-H) fixed-effect model (Fixed) for meta-analysis.

Figure 5

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: hematoma. Mantel-Haenszel (M-H) fixed-effect model (Fixed) for meta-analysis.

Figure 6

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: seroma. Mantel-Haenszel (M-H) fixed-effect model (Fixed) for meta-analysis.

Figure 7

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: wound infection. Mantel-Haenszel (M-H) fixed-effect model (Fixed) for meta-analysis.

Figure 8

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: postoperative pain evaluated by VAS at the POD one. Inverse-variance (IV) random-effect model (Random) for meta-analysis. VAS, Visual Analogue Scale; POD, postoperative day.

Figure 9

Forest plot of comparison: drain versus no drain for thyroid surgery. Outcome: hospital LOS. Inverse-variance (IV) random-effect model (Random) for meta-analysis. LOS, length of stay.

Figure S1

Funnel plot of comparison: drain versus no drain for thyroid surgery. Outcome: reoperation for bleeding (primary outcome).