Avoiding drainage after major hip surgery in children is a viable option: results from a retrospective comparative
Claudia Druschel1, Katherina Heck2, Peter Heinrich Pennekamp2
1Centre for Musculoskeletal Surgery, Department of Paediatric Orthopaedic Surgery, Campus Virchow, Charité-University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. claudia.druschel@charite.de.
Insights
Routine surgical drains in pediatric hip surgery do not reduce complications and may prolong hospital stays. This study suggests avoiding routine drain use in children undergoing these procedures.
Area of Science:
- Orthopaedic Surgery
- Pediatric Orthopaedics
- Surgical Complications
Background:
- Closed-suction drainage systems are commonly used in orthopaedic surgery despite a lack of supporting evidence.
- Drain management in pediatric patients presents unique challenges.
Purpose of the Study:
- To investigate whether surgical drains reduce complication rates in major pediatric hip procedures.
- To evaluate the impact of drains on hospitalization duration and complication incidence.
Main Methods:
- Retrospective dual-centre study comparing major hip procedures in children with (n=97) and without (n=130) closed-suction drains.
- Analysis of demographic data, pre-existing conditions, surgical details, hospitalization duration, and complication rates.
Main Results:
- No significant difference in intra-operative complications or wound-related complications between drained and undrained groups.
- The undrained group experienced significantly shorter hospitalization times.
- Complication rates were 31.9% in the drained group versus 20% in the undrained group (p=0.05).
Conclusions:
- Surgical wound drains do not positively impact complication rates in pediatric hip corrective osteotomies.
- Routine use of drains in children undergoing orthopaedic hip procedures is not recommended based on current evidence.
Purpose:
The use of closed-suction drainage systems to evacuate haematomas after surgical procedures is still common practice in many orthopaedic departments. However, no evidence to support the routine use of closed-suction drains in orthopaedic surgery exists. Post-operative handling and removal of the drain is particularly complicated in children. We hypothesised that the use of surgical drains in major hip procedures in children does not reduce the complication rate.
Methods:
The records of 63 children undergoing 97 major hip procedures managed with closed-suction drains (centre A), and 75 children undergoing 130 major hip procedures without application of wound drains (centre B) were retrospectively reviewed in this dual-centre study. Demographic data, pre-existing conditions, surgical indications and procedures, duration of hospitalisation and complication rates were analysed.
Results:
Children (mean age, 8.3 ± 4 years) in both groups presented similar demographics, medical histories, surgical indications and procedures. No intra-operative complications occurred in either group. In the undrained group a significant shorter hospitalisation time was observed. Overall, there were 31 complications (31.9 %) in the drained group and 26 complications (20 %) in undrained group (p = 0.05). Applying the Clavien-Dindo grading system, both groups had mainly minor grade I and grade II complications. No differences regarding the rate of wound-related complications were observed between the two groups.
Conclusions:
The use of wound drains in our study cohorts has been shown to have no positive impact on complications rates after corrective osteotomies around the hip joint in children. In the light of our results and of the poor evidence of drainage use in adults, we do not recommend the routine use of drains in children undergoing orthopaedic hip procedures.
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Kidney Transplant II: Surgical Procedure
01:22Aneurysm IV: Nursing Management