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Closed Wound Subfascial Suction Drainage in Posterior Fusion Surgery for Adolescent Idiopathic Scoliosis

A Prospective Randomized Control Study

Ovadia, Dror, MD; Drexler, Michael, MD; Kramer, Moti, MD; Herman, Amir, MD; Lebel, David Eduard, MD

doi: 10.1097/BRS.0000000000002892
RANDOMIZED TRIAL
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Study Design. A prospective randomized control study.

Objective. The aim of this study was to compare the complication rate in adolescent idiopathic scoliosis (AIS) posterior spinal fusion (PSF) surgery with and without drainage.

Summary of Background Data. PSF is the mainstay of surgical treatment for AIS. Drains are commonly used despite contradictory findings in the literature for their having any clear advantage.

Methods. A total of 100 AIS patients undergoing instrumented PSF were blindly randomized into two groups of either a deep drain or no drain. The collected data included wound follow-up findings, hemoglobin, hematocrit, vital signs and fever levels, and mean 20 months follow-up.

Results. Fifty-two patients were randomly allocated to the “no drain” group and 48 to the “drain” group. There were no differences in patient characteristics, surgical data, and hemoglobin and hematocrit levels between the two groups. Only 4 units of packed cells were given in total. Fever during the first postoperative 1 to 3 days was equal, but increased in the no drain group on day 6 (P = 0.017). Length of hospitalization was equal (6 days) for all the patients. The mean follow-up period was 20 months [8.5–30.7 (SD 6.4)]. Complications included one case (1.9%) of pneumonia in the “no-drain” group, wound dehiscence in two cases (3.8%) in the “no-drain” group and in one case (2.1%) in the “drain” group, and two cases (3.8%) of superficial wound infection in the “no-drain” group. There was no case of deep infection in either group.

Conclusion. The current results indicate that there is no advantage to deep drainage in AIS patients undergoing PSF. The number of wound healing complications was low and identical for both the drain and no-drain groups.

Level of Evidence: 2

A prospective randomized control study that comperes the complication rate of posterior spinal fusion in adolescent idiopathic scoliosis between patients with and without deep wound draining.

The Department of Pediatric Orthopedics Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

Department of Orthopedic Surgery, Assuta University Hospital, Ben Gurion University, Ashdod, Israel.

Address correspondence and reprint requests to Michael Drexler, MD, Department of Orthopedic Surgery, Assuta University Hospital, 7 Harefuah Street, Ashdod 7747629, Israel; E-mail: mt.drexler@gmail.com

Received 20 June, 2018

Revised 4 August, 2018

Accepted 9 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Dr. Ovadia Dror and Prof. Drexler Michael contributed equally to this work and are equally considered primary authors.

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