Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies

Juan P Cabrera; Matthew F Gary; Sathish Muthu; S Tim Yoon; Ho-Joong Kim; Samuel K Cho; Stipe Ćorluka; Stephen J Lewis; So Kato; Zorica Buser; Jeffrey C Wang; Patrick C Hsieh; AO Spine Knowledge Forum Degenerative

doi:10.1177/21925682231210184

Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies

Global Spine J. 2023 Oct 28:21925682231210184. doi: 10.1177/21925682231210184. Online ahead of print.

Authors

Juan P Cabrera^{1

2}, Matthew F Gary³, Sathish Muthu^{4

5

6}, S Tim Yoon⁷, Ho-Joong Kim⁸, Samuel K Cho⁹, Stipe Ćorluka^{10

11}, Stephen J Lewis¹², So Kato¹³, Zorica Buser^{14

15}, Jeffrey C Wang¹⁶, Patrick C Hsieh¹⁷; AO Spine Knowledge Forum Degenerative¹⁸

Affiliations

¹ Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
² Faculty of Medicine, University of Concepción, Concepción, Chile.
³ Department of Neurosurgery, Emory University, Atlanta, GA, USA.
⁴ Orthopaedic Research Group, Coimbatore, India.
⁵ Department of Orthopaedics, Government Medical College, Karur, India.
⁶ Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India.
⁷ Department of Orthopedics, Emory University, Atlanta, GA, USA.
⁸ Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of South Korea.
⁹ Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia.
¹¹ Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia.
¹² Department of Orthopaedics, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, ON, Canada.
¹³ Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan.
¹⁴ Gerling Institute, Brooklyn, NY, USA.
¹⁵ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA.
¹⁶ USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁷ Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁸ Research Department, AO Spine, AO Foundation, Davos, Switzerland.

PMID: 37897691
DOI: 10.1177/21925682231210184

Abstract

Study design: Cross-sectional survey.

Objective: Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal.

Methods: A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted.

Results: 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs.

Conclusions: Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.

Keywords: hematoma; infection; lumbar spine surgery; postoperative complications; spinal fusion; wound drain.