A clinical comparative study of thyroid surgeries with and without drain

Abstract

Most of the thyroid surgeries are accompanied by drain placement. The possibility of hematoma or seroma formation postoperatively is of concern to surgeons, as, thyroid is a highly vascular structure and a minor hemorrhage might also turn out to be life threatening, despite actual incidence of it being only 0.3-1%. Thus, drains are placed with an intention to obliterate dead space and clear the collecting blood or serum. Conversely, several studies have indicated chances of clots blocking the drainage tube and resulting in missing out of early detection of a massive bleed. Drains have also been known to add more discomfort to the patient, increase chances of infection, increase post operative pain, scar formation and longer duration of hospital stay. Thus, some surgeons believe in not placing a drain. To compare the outcomes of thyroid surgeries done with drain versus those thyroid surgeries done without drain. 40 patients, of either sex, between 18 and 70 years of age, who underwent thyroid surgeries for various thyroid disorders over a period of 6 months, were randomly allocated to either 'with drain' (group A) or 'without drain' (group B). The surgeon was made aware of drain status only intraoperatively. Patients were assessed for post-operative pain based on Visual Analogue Scale (VAS) at 6 and 24 h post-operatively. Post-operative complications including hematoma, seroma, and wound infection, if any, along with duration of hospitalization, were also documented. Patient was followed up one week post-operatively for wound check and suture removal. Both groups were homogenous according to age, sex, TIRADS, Bethesda, diagnosis and surgery performed. Postoperative pain at 6 and 24 h was significantly higher in group A than in group B [6.15 ± 1.31 vs 3.50 ± 0.88 (p = 0.001) (6 h), 4.45 ± 0.99 vs 1.20 ± 1.10 (p = 0.001) (24 h)]. Mean duration of hospitalization following thyroid surgery was significantly higher among group A than group B [3.80 ± 1.15 vs 2.15 ± 0.36 days (p = 0.001)]. Though not statistically significant, wound pain at 1 week and overall complications were higher in Group A than in Group B (p = 0.182, p = 0.127 respectively). Thyroid surgeries done without drain placement are likely to cause significantly lesser post-operative pain and shorter duration of hospitalization.

Keywords: Drain; Hematoma; Hemorrhage; Thyroid surgery; Visual analogue scale (VAS); Without drain.

Fig. 1

a and b Post-operative clinical photos of a group A and group B patient respectively showing cosmetically better scar in group B

Fig. 2

Visual analogue Scale (VAS) at 6 and 24 h. The mean VAS score for group A and group B at 6th hour post-operatively was 4–8, (6.15 ± 1.31) and 2–6, (3.50 ± 0.88) respectively, with p = 0.001 and after 24 h was 3–7 (4.45 ± 0.99) and 0–4, (1.20 ± 1.10), with p = 0.001, respectively

Fig. 3

Graph of duration of hospitalization following surgery. The mean days of hospitalization following surgery was 2–6 (3.80 ± 1.15) days, while, in Group B, it was 2–3 (2.15 ± 0.36) days (p = 0.001)