Systematic review and meta-analysis of wound drains after thyroid surgery

BackgroundDrainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains. MethodsA systematic review and meta-analysis was performed according to PRISMA guidelines. A literature search was carried out, and RCTs comparing the use of drains versus no drains in patients who underwent thyroid or parathyroid surgery were included. Trials including patients who underwent lateral neck dissection were excluded. Methodological quality was graded and data were extracted by independent reviewers. Risk ratio (RR) or mean difference (MD) with 95 per cent confidence interval (c.i.) was calculated and heterogeneity was assessed. ResultsTwenty-five RCTs were included in the meta-analysis comprising 2939 patients. There was no significant difference between the two groups in rate of reoperation for neck haematoma (RR 190, 95 per cent c.i. 087 to 414), ultrasound-assessed fluid volume on day 1 after surgery (MD 230 (95 per cent c.i. -073 to 534) ml), wound collection requiring intervention (RR 064, 038 to 109) or not (RR 093, 066 to 130), transient voice change (RR 233, 091 to 596) and persistent recurrent laryngeal nerve palsy (RR 167, 022 to 1251). Length of hospital stay was significantly greater in the drain group (MD 125 (083 to 168) days), as were wound infection rates (RR 253, 123 to 521) and pain score measure using a visual analogue scale from 1 to 10 on day 1 after surgery (MD 146 (067 to 226) units). ConclusionThe results indicate that drain use after routine thyroid surgery does not confer a benefit to patients. The use of drains is obsolete