Introduction: Use of surgical site drains following posterior cervical spine surgery is variable, and its impact on outcomes remains controversial. Studies in the lumbar spine suggest drains are not associated with reduction of reoperations for wound infection or hematoma. There is a paucity of studies examining this relationship in the cervical spine where hematomas and infections can have severe consequences.
Methods: This study is a multicenter retrospective review of 1,799 consecutive patients undergoing posterior cervical decompression with instrumentation at four tertiary care centers treated between 2004-2016. Demographic and perioperative data were analyzed for associations with drain placement and return to the operating room.
Results: Of 1,799 patients, 1,180 (65.6%) had a drain placed. Multivariate logistic regression analysis identified history of diabetes (OR 1.37, P=0.03) and total number of levels operated (OR 1.32, P<0.001) as independent predictors of drain placement. Rates of reoperation for any surgical site complication were not different between the drain and no-drain groups (4.07% vs. 3.88%, P=0.85). Similarly, rates of reoperation for surgical site infection (1.61% vs. 2.58%, P=0.16) or hematoma (0.68% vs. 0.48%, P=0.62) were not different between the drain and no-drain groups. However, after adjusting for history of diabetes and the number of operative levels, patients with drains had significantly lower odds of returning to the operating room for surgical site infection (OR 0.48, P=0.04) but not for hematoma (OR 1.22, P=0.77).
Conclusions: This large study characterizes current practice patterns in the utilization of surgical site drains during posterior cervical decompression and instrumentation. Patients with drains placed did not have lower odds of returning to the operating room for postoperative hematoma. However, our data suggests patients with drains may be less likely to return to the operating room for surgical site infection though the absolute number of infections in the entire population was small limiting the analysis.
Patient Care: At most morbidity and mortality conferences I have been to around the country, whether or not to leave a drain following posterior cervical instrumented decompressions is hotly debated. Proponents of drains state they decrease post-operative hematoma/infection rates. Others feel they add no benefit, may serve as a conduit for introduction of infection and actually increase infection rate, and add to patient length of stay.
There is no meaningful data in the literature about this topic. The current study provides data analyzing 1,799 patients regarding this controversy. Patients were collected from both neurosurgeons and orthopedic surgeons at 3 academic centers and one "privademic" practice, making the results somewhat generalizable.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Understand the theoretical pros and cons of leaving a drain after posterior cervical spine surgery.
2. Understand the data presented on complication rates with and without drains following posterior cervical spine surgery.
3. Have better information to help surgeons decide whether or not to leave a drain after posterior cervical spine surgery