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Jackson-Pratt drainage in pediatric craniofacial reconstructive surgery: is it helping or hurting?
Kumar Vasudevan1,2, Ahyuda Oh3, R Shane Tubbs4
1Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta.
Insights
Jackson-Pratt drains (JPDs) in pediatric craniofacial reconstructive surgery (CRFS) show no increased risk of complications like blood loss or hyponatremia. However, their specific benefits in CRFS remain unclear from this study.
Area of Science:
- Pediatric Surgery
- Plastic Surgery
- Surgical Outcomes
Background:
- Jackson-Pratt drains (JPDs) are frequently used in pediatric craniofacial reconstructive surgery (CRFS) to mitigate wound complications.
- The safety and risk profile of JPDs in this specific pediatric population are not well-established.
- Perioperative blood loss and fluid shifts are significant concerns in CRFS.
Purpose of the Study:
- To assess the risks associated with JPD usage in pediatric craniofacial reconstructive surgery.
- Specifically evaluate the impact of JPDs on perioperative blood loss, hyponatremia, ICU length of stay, and wound complications.
Main Methods:
- Retrospective review of pediatric patients undergoing CRFS between 2010 and 2014.
- Comparison of outcomes between patients who received JPDs and those who did not.
- Analysis included blood transfusion needs, hemoglobin, hematocrit, serum sodium levels, and length of stay.
Main Results:
- No significant differences in baseline characteristics between JPD and no-JPD groups.
- Average JPD output was 222 ± 142 ml over 48 hours.
- No significant differences in perioperative blood loss, transfusion requirements, electrolyte levels, or ICU/hospital length of stay were observed.
Conclusions:
- JPD use in pediatric CRFS is not associated with increased perioperative complications.
- The study did not identify significant risks but also did not confirm clear benefits of JPDs in this context.
Abstract:
OBJECTIVE Jackson-Pratt drains (JPDs) are commonly employed in pediatric craniofacial reconstructive surgery (CRFS) to reduce postoperative wound complications, but their risk profile remains unknown. Perioperative blood loss and volume shifts are major risks of CFRS. The goal of this study was to evaluate the risks of JPD usage in CFRS, particularly with regard to perioperative blood loss, hyponatremia, intensive care unit (ICU) length of stay, and postoperative wound complications. METHODS The authors performed a retrospective review of data obtained in pediatric patients who underwent CFRS at a single institution, as performed by multiple surgeons between January 2010 and December 2014. Data were gathered from patients who did and did not receive JPDs at the time of surgery. Outcome measures were compared between the JPD and no-JPD groups. RESULTS The overall population 179 pediatric patients: 128 who received JPDs and 51 who did not. In their analysis, the authors found no significant differences in baseline patient characteristics between the two groups. The average JPD output over the first 48 hours was 222 ± 142 ml. When examining the immediate preoperative to immediate postoperative time period, no significant differences were noted between the groups with regard to the need for blood transfusion or changes in hemoglobin, hematocrit, or serum sodium levels. These differences were also not significant when examining the 48-hour postoperative period. Finally, no significant differences in hospital length of stay, ICU length of stay, or emergency department visits at 60 days were noted between the two groups. CONCLUSIONS In this retrospective study, the use of JPDs in pediatric CFRS was not associated with an increased risk of serious perioperative complications, although the benefits of this practice remain unclear.
