Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial. (1st September 2022)

• Record Type: Journal Article
• Authors: Helenius, Linda; Gerdhem, Paul; Ahonen, Matti; Syvänen, Johanna; Jalkanen, Jenni; Charalampidis, Anastasios; Nietosvaara, Yrjänä; Helenius, Ilkka
• Is Part Of: Bone & joint journal. Volume 104B:Number 9(2022)
• Page Start: 1067
• Page End: 1072
• Publication Date: 2022-09-01
• Subjects: Adolescent idiopathic scoliosis -- Pedicle-screw instrumentation -- Posterior spinal fusion -- Subfascial drain -- Postoperative pain -- Haemoglobin -- Adolescent Idiopathic Scoliosis -- pedicle screws -- wound -- multicentre randomized controlled trial -- blood loss -- surgical site infection (SSI) -- opioids -- oxycodone -- wound closure -- idiopathic scoliosis; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B9.BJJ-2022-0391.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Methods: Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. Results: All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1, 008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. Conclusion: Leaving the subfascial drain out after pedicle screw instrumentation for AIS is not associated with higher postoperative haemoglobin levels. Patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain. Cite this article: Bone Joint J 2022;104-B(9):1067–1072.