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Meta-analysis: prophylactic drainage and bleeding complications in thyroid surgery
Stephen A Kennedy1, Robert A Irvine, Brian D Westerberg
1Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia. sakennedy@mac.com
Insights
Prophylactic drain placement in thyroid surgery does not show a significant benefit in reducing bleeding events. Current evidence is insufficient to recommend routine drain use, as drains may potentially increase reoperation risk for bleeding.
Area of Science:
- Endocrinology
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Thyroid surgery is common, and bleeding is a potential complication.
- The use of prophylactic drains to mitigate bleeding risks is debated.
Purpose of the Study:
- To systematically review and meta-analyze evidence on prophylactic drain placement in thyroid surgery.
- To determine the impact of drains on adverse bleeding events.
Main Methods:
- Comprehensive search of multiple databases (MEDLINE, EMBASE, etc.).
- Inclusion of prospective trials; exclusion of retrospective studies and selective drainage.
- Two independent reviewers selected articles; QUORUM guidelines followed.
Main Results:
- 16 studies included, with 8 used for meta-analysis (10 RCTs).
- No statistically significant benefit or harm from drain use was found.
- Meta-analysis showed non-significant odds ratio of 1.47 for reoperation and 0.88 for hematoma.
Conclusions:
- Insufficient evidence exists to support routine prophylactic drain placement in thyroid surgery.
- Drains might slightly increase reoperation risk for bleeding, though not statistically significant.
- Potential benefits of drainage may not outweigh risks or justify routine use.
Objective:
To conduct a comprehensive systematic review and high-quality meta-analysis to determine whether prophylactic drain placement reduces adverse bleeding events in thyroid surgery.
Data Sources:
MEDLINE (OVID and PubMed), CENTRAL, CDSR, ACP Journal Club, DARE, EMBASE, PREMEDLINE, OLDMEDLINE, CINAHL, BIOSIS Previews, LILACS, KOREAMED, SAMED, IndMED, SIGLE, ScienceDirect, and INGENTACONNECT.
Review Methods:
Studies for evaluation included all prospective trials assessing the use of drainage in thyroid surgery. We excluded case studies, retrospective studies, reviews, and studies that had a "selective" method of postoperative drainage that was not defined or was based on surgeon preference. Search strategies were broad and based on Cochrane Collaboration search filters. There was no language restriction. Article selection was conducted by two independent reviewers under QUORUM guidelines.
Results:
Four hundred sixty-two articles were identified by the search strategy used, and 16 articles were included in the final review. Ten studies were randomized controlled trials, with 8 used for quantitative meta-analysis. No study showed a statistically significant benefit or harm with drain use. Meta-analysis of data estimated an odds ratio of 1.47 for reoperation for bleeding and 0.88 for visible hematoma for suction drains versus no drains. The results were not statistically significant, and 95% confidence intervals were wide.
Conclusion:
The literature has insufficient evidence to recommend routine drainage in thyroid surgery. It is possible that drains may increase the risk of reoperation for bleeding, although the data are not statistically significant. If there is a benefit to drainage, absolute risk reductions of bleeding outcomes may not warrant routine use.
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