Wound drains in non-complex lumbar surgery: a systematic review

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Post-operative complications like epidural hematomas and wound infections are concerns in lumbar spine surgery.
• The use of wound drainage in non-complex lumbar procedures remains a debated topic regarding its efficacy.

Purpose of the Study:

• To systematically review literature and assess the incidence of post-operative epidural hematomas and wound infections.
• To compare complication rates in patients undergoing one- or two-level lumbar surgery with or without post-operative wound drainage.

Main Methods:

• Systematic literature search of PubMed and EMBASE up to August 2015.
• Inclusion of studies on one- or two-level lumbar discectomy and/or laminectomy for degenerative disease in adults.
• Analysis of studies reporting any form of subcutaneous or subfascial drainage.

Main Results:

• Eight studies involving 1333 patients were included in the review.
• Clinically relevant post-operative epidural hematomas occurred in 0.15% of patients (2/1333).
• Wound infections occurred in 0.75% of patients (10/1333).
• Epidural hematomas occurred in 0.47% of patients with drainage (2/423) vs. 0% without (0/910).
• Wound infections occurred in 0.47% of patients with drainage (2/423) vs. 0.88% without (8/910).

Conclusions:

• Routine wound drainage in non-complex lumbar surgery does not appear to prevent post-operative epidural hematomas.
• The absence of a wound drain does not lead to a significant increase in the incidence of wound infection following this type of surgery.