Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis

Abstract

Purpose: The clinical use of closed-suction drainage, which aims to reduce postoperative wound haematomas and infection, is common. This study was performed to determine whether closed-suction drainage is safe and effective in promoting wound healing and reducing blood loss and other complications compared with no-drainage in total hip arthroplasty.

Methods: The literature search was based on PubMed, the Cochrane Library, MEDLINE, and EMBASE. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group, and then analysed using RevMan 5.0. Twenty randomised controlled trials involving 3,186 patients were included in our analysis.

Results: The results of our meta-analysis indicate that closed-suction drainage reduces the requirement for dressing reinforcement, but increases the rate of homologous blood transfusion. No significant difference was observed in the incidence of infection, blood loss, changes in haemoglobin and haematocrit, functional assessment, or other complications when the drainage group was compared with the no-drainage group.

Conclusions: Our results of the comparison between closed-suction drainage and no drainage in THA have indicated that the routine use of closed-suction drainage for elective total hip arthroplasty may be of more harm than benefit.

Figures

Fig. 1

Flow chart of included and excluded studies

Fig. 2

Forest plot diagram showing a summary of the results of the meta-analysis. BN Blood transfusion (no. of patients), BA Blood transfusion (amount of blood per patient)

Fig. 3

Forest plot diagram showing the influence of closed-suction drainage on wound infection. CI confidence interval, SD standard deviation, IV inverse variance, df degrees of freedom, M–H Mantel–Haenszel

Fig. 4

Forest plot diagram showing the influence of closed-suction drainage on homologous transfusion

Fig. 5

Forest plot diagram showing the influence of closed-suction drainage on reinforcement of the dressing