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Surgical drains provide no protection against postop THR infection
Significantly more patients who received surgical drains required blood transfusions following surgery.
Surgical drains do not help to improve protection against postoperative infections and may increase the need for blood transfusions following total hip replacement, a prospective study shows.
Phil J. Walmsley, MRCS(Ed), and colleagues at the Queen Margaret Hospital in Fife, Scotland, randomly assigned 552 primary THR patients to receive either a 3-mm Redivac drain or no drain upon completion of surgery. The researchers excluded patients undergoing revision procedures and those who had preoperative skin pathology.
Six surgeons at two hospitals performed all procedures using a standard anterolateral approach and implanted either the Elite Plus or Charnley (DePuy) prostheses. All patients had their wounds dressed with hip-spica bandages. Patients in the drain group had their wound drains removed after 24 hours. After 48 hours, all bandages were inspected and all patients were mobilized, according to the study.
Of the 552 patients (577 procedures), 282 patients received drains and 295 did not. Both groups were similar in terms of gender distribution, age, body mass index and smoking history. Additionally, both groups had similar pre- and postoperative hemoglobin levels as well as similar postop durations of hospitalization, the authors noted in the study.
However, the researchers found that significantly more drained patients required postoperative blood transfusions — 33% vs. 26.4% of undrained patients (P=.042).
“Our results show a clear advantage with respect to rates of transfusion when drains were not used,� the authors noted.
“Drains provide no advantage to patients undergoing [THR], represent an additional cost and expose the patient to potentially adverse events such as blood transfusion,� they said. “We would recommend discontinuing routine use of drains at uncomplicated total hip arthroplasty.�
The researchers found no other significant differences between groups. Twenty-five drained patients (9%) and 23 undrained patients (8%) were unable to complete the required three-year follow-up. Four drained patients died during the early postoperative period; two due to myocardial infarction, one from a cerebrovascular event and one due to pneumonia. Another 11 drained patients died during follow-up due to unrelated causes and 10 were lost.
Similarly, 10 undrained patients died due to unrelated causes and 13 were lost during follow-up. No patients in either group experienced wound dehiscence, and only one undrained patient developed profound thigh swelling due to a large hematoma, according to the study.
Drained patients experienced 19 superficial infections compared with 23 such infections in undrained patients. Antibiotics successfully treated all infections in undrained patients and in 18 of the 19 drained patients. The remaining one infection in a drained patient developed into a deep infection within three months postop and eventually required excision arthroplasty.
The undrained group also experienced two cases of deep infection. One deep infection developed one year postop and required a one-stage revision. The second case developed at 22 months postop following a urological procedure and required a two-stage revision, according to the study.
There was no difference in Harris Hip Scores between the groups throughout follow-up, the authors noted.
For more information:
- Walmsley PJ, Kelly MB, Hill RMF, Brenkel I. A prospective, randomized, controlled trial of the use of drains in total hip arthroplasty. J Bone Joint Surg Br. 2005;87-B:1397-1401.