To Drain or Not to Drain in Thyroidectomy: A Meta-analysis of Outcomes

Abstract

Background: There is a traditional belief that a drain placed after thyroid surgery can prevent life-threatening hemorrhage and a hematoma from forming. We conducted a meta-analysis to review the outcomes of a drain placement versus no drain placement following thyroid surgeries.

Methods and Materials: Data was extracted using the Medical subject heading and key words “Drainage”, “Thyroid”, “Thyroidectomy”, “subtotal thyroidectomy” “Goitre” and “Thyroid cancer” in PubMed Central, Embase, Pubmed, Cochrane library, Central Register of controlled Clinical Trials, ICTRP, CINAHL and Google Scholar. Further articles were identified by following the authors and references cited in the selected studies.

Methods: Randomized controlled trials and comparative studies monitoring patients who underwent thyroidectomy, subtotal thyroidectomy, and thyroidectomy with neck dissection for malignancy and lobectomy and isthmectomy for benign nodular goiter, with documentation of drain or no drain placement were included in the study. Single arm trials, cohort studies, retrospective studies, drains placed following parathyroid surgery were excluded. Qualitative studies of randomized controlled trials were reviewed using the Cochrane collaboration scheme on RevMan 5.4. Meta-analysis was assessed with odd ratio and standard mean difference using fixed effect model. The primary outcomes analyses were post-operative complications, re-operation rates, post-operative pain and length of hospital stay.

Results: We found 27 randomized controlled trials with 3297 patients, 1671 had drain placements and no drain was placed in 1626 patients. The odd ratio of wound infection was 2.9%( 95% CI 1.6% to 5.3%), hematoma was 1% (95% CI 0.6% to 1.7%), seroma was 0.8% (95% CI 0.5% to 1.4%), hemorrhage was 1.5%( 95% CI 0.7% to 3.4%), re-operation was 1.6% ( 95% CI 0.8% to 3.2%), hypocalcaemia was 1.7% ( 95% CI 1.2% to 2.5%), postoperative pain was 1.2%(  95% CI 1% to 1.3%) and length of stay was 0.9% ( 95% CI 0.8% to 1%).

Conclusion: There is significant difference in post-operative complications, incidence of post-operative pain and length of hospital stay in patients who have drain placement compared to those with no drain placement. However, seroma formation is observed more frequently in patients who have no drain placed after thyroid surgery