The impact of drains on surgical outcomes in thyroid surgery-a meta-analysis of randomised controlled trials

Thyroidectomy is a commonly performed procedure with potential complications such as haematoma and seroma, which can result in life-threatening airway obstruction. Surgical drains have traditionally been used to mitigate these risks, but their necessity is increasingly debated due to concerns over pain, infection, and prolonged hospitalisation.

To evaluate the benefits and risks of using surgical drains following thyroidectomy. This meta-analysis of randomised controlled trials aimed to compare postoperative surgical outcomes in adult patients undergoing thyroid surgery, managed with or without drains.

Five electronic databases (PubMed, EMBASE, Ovid Medline, EMCARE, and CINAHL) were systematically searched in August 2025 for articles published between January 1995 and August 2025.

Randomised controlled trials (RCTs) comparing outcomes in patients undergoing thyroidectomy with and without drains were included. Of the initial 119 articles identified, 10 RCTs were included in the final analysis, representing 1,078 patients.

Pooled proportions were calculated and transformed using the Freeman-Tukey double arcsine method. The random-effects meta-analysis of proportions was then conducted using inverse variance weighting, with between-study variance (τ²) estimated via the DerSimonian and Laird method.

Primary outcomes included haematoma and seroma rates; secondary outcomes were surgical site infection (SSI), return-to-theatre (RTT), postoperative pain, and length of stay (LOS).

Pooled complication rates were: haematoma 1.6%, seroma 3.7%, SSI 2.5%, and RTT 0.2%. Drain use was not associated with significant differences in haematoma (p = 0.15), seroma (p = 0.64), or RTT (p = 0.22). However, SSI (4.2% vs. 0.5%, p = 0.01), LOS (mean difference [MD] = 1.2 days; p < 0.0001), and pain (MD = 2.2; p = 0.001) were significantly higher in the drain group.

Routine placement of drains after all types of thyroidectomies does not significantly decrease the rates of haematoma, seroma, or recurrent laryngeal nerve injury, and is linked to higher rates of surgical site infection, pain, and length of stay. A selective, patient-specific approach to drain use is recommended.