Sunday, July 17, 2016

Should closed suction drains be used in shoulder arthroplasty?

Are Post-Operative Drains Beneficial in Total and Reverse Total Shoulder Arthroplasty?

These authors reviewed their patients having total anatomic or reverse shoulder shoulder. 304 had a postoperative closed suction drain and 64 did not.

Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed.

In this study, drain usage was associated with significantly lower postoperative hemoglobin, longer length of stay, and lower postoperative Simple Shoulder Test scores. 

Comment: In that this was not a controlled study, we do not know why some patients received drains and others not. it is possible that the results could be explained by the surgeons using drains on the cases that were bleeding more at surgery or on sicker patients.

We prefer not to use drains in shoulder arthroplasty for a different reason: the tubing creates an open connection between the skin surface and dermis, which harbor Propionibacterium, and the depth of the wound where the prosthesis is at risk for colonization. In that we move the shoulder right away after surgery, the situation can be worsened by the drain tube sliding back and forth as the shoulder moves.


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