Association Between Cervical Drainage and Early Post-Thyroidectomy Outcomes: A Systematic Review and Meta-Analysis

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93-1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46-2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42-3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70-1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85-1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59-1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes.