Patient outcomes with use and non-use of drain after thyroidectomy for clinically benign lesions. a prospective randomized clinical study
Muthaa, Titus K
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Background: Prophylactic drainage in thyroid surgery has been a regular but experimental practice with no scientific evidence to support its gain. Current results recommend that postoperative haematoma cannot be averted by using drains after total thyroidectomy for benign thyroid disorders. Moreover, the use of drains may augment postoperative pain and the pain reliever requirement, and prolong the hospital stay. In view of these findings, the regular use of prophylactic drains might not be essential after thyroid surgery for benign disorders. In our setup there is no protocol on usage of drains after thyroid surgery. Most studies on drain use have been done in the western countries where goiters are much smaller. Furthermore, they are done in sub specialist endocrine centers as opposed to our general surgical centers, hence a need for local study. This study aimed at evaluating the difference in outcomes in drained versus non- drained groups after total thyroidectomy and total lobectomy for benign thyroid disorders. Objective: This prospective randomized clinical study sought to evaluate the difference in outcomes in drained versus non-drained groups after total thyroidectomy and total lobectomy for benign thyroid disorders. Study design: Prospective randomized clinical study consisting of 90 patients who were admitted for either total thyroidectomy or total lobectomy, who were randomized into two groups of 45 participants each to receive a post-operative drain or not. Setting: The general surgical wards and theatres at Kenyatta National Hospital. Patients and Method Ninety consecutive patients with benign thyroid disorders scheduled for total thyroidectomy or total lobectomy, who met the inclusion criteria were recruited over a study period of 9 months from January to September 2011. Postoperative outcomes evaluated included haematoma and seroma formation, postoperative pain; assessed by the visual analogue scale rv AS), duration of hospital stay, histological diagnosis and necessity for re-operation. The data was collected using a structured questionnaire. It was entered into the MS ExcefM spreadsheet exported to STATAﾙ version 10 (College Station, Texas, USA) for analysis. Participants were randomly assigned to one group in whom closed drains were used and another in whom no drains were used. Randomization was carried out using a computerdeveloped table of random numbers. This randomization was done by an autonomous infonnation technologist consultant. The surgeon was made aware of the group designation just before the closure ofthe wound. Results The mean V AS score was noted to be significantly reduced in the non-drained group patients at 6 hours, 12 hours and 24 hours postoperatively (p= 0.001). Four cases of hematoma (8.9%) occurred in the drained group, whereas none of patients in the non-drained group developed hematoma (0.00%). There was no one among the patient in the non-drain group who had post-surgery wound infection whereas four (9%) of those who had drains developed wound sepsis. No participant required re-operation for any complication nor developed seroma and all complications were successfully managed conservatively. Patients in the non-drained group had a significantly shorter length of hospital stay compared to those in drained group (p = 0.001). On average, patients in the non-drained group stayed in hospital for 1.2 days [SD 0.06] and those in the drained group stayed on for 3.2 days [SD 0.12]. Conclusion The present prospective randomized study verifies that regular drainage of thyroid bed after total thyroidectomy or total lobectomy for benign disorders is not essential and may induce rather than avert fluid collection. The use of drains was found not to be useful in decreasing the rate of postoperative complications such as haematoma, seroma and wound infection. It was also found to elevate pain after surgery, prolong the hospital stay and may be related to an increased risk of surgical site infection. From the finding of this study, regular use of drains after thyroid surgery for benign disease may therefore not be desirable.