Is a wound drain needed routinely after anterior cervical discectomy and fusion?

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Background: Postoperative subfascial wound drains are commonly used in anterior cervical discectomy and fusion (ACDF) surgeries to help lower the risk of complications from postoperative haematomas (POHs) and surgical site infections (SSIs). However, controversy surrounding their efficacy remains, due to limited guidelines and a lack of conclusive evidence. The primary aim of this study is to determine whether placing a drain routinely offers any therapeutic benefit for postsurgical outcomes in ACDF intervention, hence re-evaluating their routine use in clinical practice. Methods: This retrospective study analyzed on patients who underwent ACDF procedures between January 2013 and December 2023 at a tertiary neurosurgical centre in the UK. Patients were categorized into drain and nondrain cohorts and stratified according to several predictor variables including baseline demographics, and clinico-social characteristics. The primary outcome measure investigated in this study was the incidence of postoperative complications and length of stay (LOS) between those who received a drain and those who did not. Results: A total of 1,938 patients met the inclusion criteria and were included in our analysis. Of these patients, 1,614 (83.3%) had subfascial drains placed during surgery. Baseline demographics differed slightly between both cohorts, with patients in the drain group having a higher median age (p=.02), and a significantly higher proportion were male (p=.02), hypertensive (p<.01), drank alcohol (p<.01) and smoked (p=.04). Between the 2 groups, we observed no significant difference in rates of reoperation for POHs (p=.43), SSIs (p=.85) or LOS (p=.18). Conclusions: Our study found no significant differences in the incidence of POHs or SSIs between post-ACDF patients with drains and those without, nor was there any difference in postoperative length of stay between the groups. Therefore, our results do not support the routine use of subfascial drains in clinical practice.

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