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Utilization of Drains and Association With Outcomes: A Population-Based Study Using National Data on Knee Arthroplasties

Poeran, Jashvant MD, PhD; Ippolito, Katherine BS; Brochin, Robert MD; Zubizarreta, Nicole MPH; Mazumdar, Madhu PhD; Galatz, Leesa M. MD; Moucha, Calin S. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 - Volume 27 - Issue 20 - p e913-e919
doi: 10.5435/JAAOS-D-18-00408
Research Article

Introduction: Although surgical drains have been used routinely in total knee arthroplasties (TKAs), results from several large trials have led to recommendations against their use. Because national data are lacking, we aimed at assessing utilization patterns of drains and perioperative outcomes in TKA procedures.

Methods: We included 1,130,124 TKA procedures from the national claims-based Premier Healthcare Database (2006 to 2016). Patients receiving a drain were compared with those who did not. Multivariable multilevel models measured associations between drain use and blood transfusions, postoperative infections, 30-day readmission, and length/cost of hospitalization. Odds ratios and 95% confidence intervals are reported. Propensity score analyses were performed to assess the robustness of results.

Results: Drain use decreased from 33.0% (n = 22,901 of 69,370) in 2006 to 15.6% (n = 19,418 of 124,440) in 2016 and was particularly higher in large (>500 beds; 27.1%) and nonteaching hospitals (26.9%). After adjustment for relevant covariates, the use of drains (compared with no use) was significantly associated with increases in particularly blood transfusions (odds ratio, 1.27; 95% confidence interval, 1.24 to 1.30 n = 138,306 total transfusions), whereas minimal effects were seen for other outcomes. Propensity score analyses confirmed these results.

Discussion: Although retrospective, the current study provides an important insight into real-world clinical practice regarding the use of drains. With current evidence not supporting their use in TKA, we found that national utilization is slowly decreasing. Moreover, because drain use is associated with negative outcomes, future studies should focus on drivers of their continued use.

Level of Evidence: Level III, therapeutic study

From the Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (Dr. Poeran, Ms. Zubizarreta, and Dr. Mazumdar), Leni and Peter W. May Department of Orthopaedic Surgery (Dr. Poeran, Ms. Ippolito, Ms. Zubizarreta, Dr. Brochin, Dr. Galatz, and Dr. Moucha), and the Department of Medicine (Dr. Poeran), Icahn School of Medicine at Mount Sinai, New York, NY.

Correspondence to Dr. Poeran:

Dr. Galatz or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and American Shoulder and Elbow Surgeons. Dr. Moucha or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of 3M and Biocomposites. None of the authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Ethical review committee statement: The Mount Sinai Hospital Review Board considers this study exempt based on the deidentified Health Insurance Portability and Accountability Act (HIPAA) compliant nature of the data (project #14-0067).

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Copyright 2018 by the American Academy of Orthopaedic Surgeons.
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