Closed-Suction Drain Use in Shoulder Arthroplasties

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Closed-suction drainage after total hip (THA), knee (TKA), and shoulder (TSA) arthroplasty has been routinely used by surgeons for years. This procedure was thought to improve healing and reduce infections; however, these benefits have not been proven in THA and TKA literature. Research in this area has found closed-suction drainage increases post-operative blood-loss, elevates the need for blood transfusions, escalates the risk of infection and has no proven benefits in healing wounds.

Despite current research showing the lack of benefits in using closed-suction drainage after THA and TKA, there has been little research on the benefits or risks of closed-suction drainage on TSA. As a result, Columbia Orthopedics providers David P. Trofa, MD, Charles M. Jobin, MD, William N. Levine, MD and Christopher S. Ahmad, MD conducted a prospective evaluation of drain use in TSA to determine the benefits, risks, and costs associated with this procedure. 

“Drains are commonly used after shoulder arthroplasties, despite no evidence that they improve patient outcomes. In fact, literature from hip and knee arthroplasty investigations have shown that drains increase post-operative transfusion rates and result in increased hospital costs,” said Dr. Trofa. “The purpose of this prospective randomized controlled trial was to assess immediate outcomes during the peri-operative period associated with drain use in the setting of a shoulder arthroplasty.”

The study, titled “Short-term outcomes associated with drain use in should arthroplasties: a prospective, randomized controlled trial,” was conducted at a tertiary referral center and studied 100 consecutive TSA patients from December 2015 to 2017, who did or did not receive closed-suction drainage devices at the time of the surgery. Patient demographic information as well as intraoperative and post-operative data was collected for each patient. Columbia Orthopedics providers hypothesized that the drain use would result in lower hemoglobin (HgB) and hematocrit (Hct) levels, higher transfusion requirements, longer hospital durations, and increased cost; but no differences in wound complications. As hypothesized, the drain use had no effect on the immediate post-operative outcomes of patients undergoing TSA. However, the results also illustrated that drain use had no effect on post-operative blood transfusions and was not associated with an increased hospital stay.

“After randomizing 100 patients we identified no significant differences between patients who received a drain and those that did not,” stated Dr. Trofa. “Additionally, we found an average cost increase of $7,423.00 associated with drain use, which while not statistically significant, represents a significant yet unnecessary healthcare expenditure. As such, we concluded that while drain usage is safe, it is unnecessary for routine shoulder arthroplasty cases.”

Read the full article in the Journal of Shoulder and Elbow Surgery.