Rethinking drain protocols in pediatric thyroidectomy

Pediatric thyroidectomy is an uncommon procedure performed for many diagnoses. Literature from adult populations suggests drain use following thyroidectomy does not alter hematoma or seroma risk and may increase infection risk, however this has not been explored in the pediatric population. The objective of this study was to determine if drain use altered risk of postoperative complication in pediatric thyroidectomy patients.

We conducted a retrospective case series examining individuals under 21 years of age who underwent thyroidectomy with or without central (CND) or lateral neck dissection (LND) for any indication between July 2011 and October 2024 at a tertiary children's hospital. The primary measured outcome was relative risk of complication comparing drain or no drain following thyroidectomy.

Two hundred eighty-nine individuals underwent 310 procedures. Drains were placed in 95/277 (34.2 %) total thyroidectomies without neck dissections. Drains were placed in 15/16 (94 %) thyroidectomies with LND±CND and 9/17 (52.9 %) thyroidectomies with only CND. No complication was seen following neck dissection. No hematomas occurred with a drain and one occurred without a drain. Three infections occurred, one with a drain and two without. One seroma occurred with a drain. The relative risk of complication following thyroidectomy without neck dissection and no drain was 0.78 (95 % CI: 0.13, 4.61).

Post thyroidectomy complications are rare and the decision to forgo drain placement did not increase risk of complication in a pediatric cohort. No complications were seen with CND regardless of drain status suggesting drains may not be necessary in this population.