No Significant Evidence to Support Neck Drain Insertion After Thyroidectomies

What does current evidence on potential risks of intraoperative placement of neck drains in patients undergoing thyroidectomies indicate about its use as a widespread practice?

BOTTOM LINE: The practice of neck drain insertions in patients undergoing thyroidectomies is associated with higher risks of hematomas and surgical site infections, and longer hospital stays.

BACKGROUND: Routine drainage following thyroidectomy is standard surgical practice, as it is thought to prevent secretion accumulations that could lead to complications; however, recent research challenges the need for, and even advisability of, this practice. There are no current specific guidelines for postoperative management of thyroidectomies regarding intraoperative neck drain placement.

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Basingstoke and North Hampshire Hospital, Basingstoke, UK, and William Harvey Hospital, Ashford, UK

SYNOPSIS: Researchers performed a comprehensive literature search to identify randomized controlled trials evaluating postoperative complications associated with neck drains. Sixteen articles were included for final quantitative analysis. Primary outcome measures involved investigation of the impact of neck drain insertion post-thyroidectomies on hematoma rates, surgical site infections, hospital stay duration, and volume of fluid in thyroid bed. Eight of the 12 studies that reported on hematomas showed higher risk of hematoma development in the drained group. Of 11 studies included in the surgical site infection meta-analysis, nine demonstrated higher odds of infection development in the drained group. All 11 studies that investigated the impact of neck drain insertion on hospital stay duration associated the practice with longer stays, likely due to predetermined drain output thresholds prior to release. Of the four studies that investigated the impact of neck drains on thyroid bed fluid volumes, all associated drain insertion with lower volumes. Study limitations included the heterogenous usage of drain types and a generally high risk of bias across studies.

CITATION: Soh TCF, Ong QJ, and Yip HM. Complications of neck drains in thyroidectomies: A systematic review and meta-analysis. Laryngoscope. 2021;131:690-700.