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Comparative Outcomes of Drain and Drainless Techniques in Parotidectomy: A Systematic Review and Meta-Analysis
Salman Hussain1, Jafar Hayat2, Bashayer AlSaeedi2
1Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.
Objective:
This study compares complications between drainless parotidectomies versus parotidectomies where drains were inserted post-operatively.
Data Sources:
PubMed, MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Web of Science databases.
Review Methods:
This systematic review and meta-analysis compared outcomes of parotidectomy with and without intraoperative drain insertion. A comprehensive database search was conducted in accordance with PRISMA reporting guidelines, yielding 186 articles, of which 21 met the inclusion criteria. Studies were assessed for risk of bias using the Newcastle-Ottawa Scale for non-randomized studies and the Cochrane Risk of Bias 2.0 tool for randomized controlled trials. Post-operative complication rates - including hematoma, seroma, and sialocele formation - were extracted and analyzed.
Results:
The database search yielded 284 citations, of which 98 citations were omitted due to duplication. Of the remaining 186 citations, 142 were omitted during title/abstract screening, and the remaining 43 underwent full-text screening, of which 22 were excluded, resulting in 21 studies included in the systematic review and 5 being included in quantitative analysis. Across included studies, 3138 individuals underwent parotidectomy (2263 with drains and 875 without). No significant differences were found between drain and drainless groups in hematoma (OR = 0.9, CI: 0.14 to 5.7, P = .91) or sialocele/seroma formation (OR = 0.45, CI: 0.17 to 1.18, P = .10). In single-arm studies, hematoma rates were similar (1.03% with drains vs 0.5% without), while sialocele/seroma rates were higher in drainless cases (11.5% vs 6.4%).
Conclusion:
There was no significant difference in complication rates post-operatively between the drain and no drain groups, with an increased length of hospital stay in the drain group, and a trend toward higher seroma rates in the drainless group. Nevertheless, it is feasible to perform outpatient parotidectomy with drains.
