A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study. (16th November 2020)

• Record Type: Journal Article
• Authors: Chang, Victor W; Lim, Seokchun; Bazydlo, Michael; Yeh, Hsueh-Han; Nerenz, David; Abdulhak, Muwaffak; Schwalb, Jason M; Schultz, Lonni; Easton, Richard; Khalil, Jad; Aleem, Ilyas; Park, Paul; Macki, Mohamed; Hamilton, Travis M
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_768
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Routine use of drains placed in the retropharyngeal space after elective ACDF remains controversial. Given the push by some payors to classify ACDF as an outpatient procedure, it is unlikely that routine use of drains can be maintained in such a setting. The evidence to support the routine use of drains remains limited at best. METHODS: All patients undergoing ACDF, without corpectomy, between February 2014 and October 2019 were identified in the registry of the Michigan Spine Surgery Improvement Collaborative (MSSIC). Cases were divided into two cohorts, drain and no drain, matched for: age, BMI, diabetes, CAD, ASA grade, ambulatory status, and number of levels of surgery. Primary outcome measures were: surgical site hematoma requiring return to OR (SSH), surgical site infection (SSI), dysphagia, readmission within 30 days (30RA) and 90 days (90RA), and length of stay (LOS). RESULTS: 8, 283 patients underwent ACDF during the study period. After matching there were 3, 206 patients in both the drain and no-drain cohort. Comparing the drain to no-drain cohort, the incidence of SSH was 0.7% vs 1.1% ( P = .038), SSI 0% vs 1% (n.s.), dysphagia 5% vs 6% ( P = .003), 30RA 3% vs 3% (n.s.), 90RA 5% vs 6% (n.s.), and median LOS 1 day(IQR 1, 1) vs 1 day(IQR 1, 2) ( P < .001). On multivariate analysis, drain use was associated with a 47% relative risk reduction of SSH (OR 0.53, CI 0.31 to 0.9). There was also a trend toward increased risk of 30RA (OR 1.26, CI 0.94 to 1.7, P = .08) with drain usage, and a significant risk of increased length of stay (OR 1.31, CI 1.2 to 1.44, P < .001). CONCLUSION: We observed a rate of 0.7% and 1.1% incidence of SSH with and without drain use respectively. This represents an absolute risk reduction of 0.4% and a relative risk reduction of 47%. Whether this incremental benefit is worth the tradeoff of increased length of stay warrants consideration.g.