Jackson Philippa C, MacInnes Emma G, Nicholson Jane K, Brayshaw Ian, Relton Samuel, Achuthan Raj
Plastic Surgery, Southmead Hospital, Bristol, GBR.
Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR.
Cureus. 2019 Jul 17;11(7):e5160. doi: 10.7759/cureus.5160.
Introduction Use of drains after mastectomy remains highly variable. This study aimed to establish whether simple mastectomy managed without a drain would cost less than the same procedure managed with a drain and whether there would be any difference in complications. Methods Prospective data were collected on all patients undergoing simple mastectomy ± sentinel lymph node biopsy over sixteen months. Surgeons decided intra-operatively whether to place a drain. Data included operative details, mastectomy weight, length of stay and postoperative complications. Costing data were identified by combining hospital finance costs for admission and follow-up appointments along with the cost of consumables. Results One hundred and thirty mastectomies were performed on 119 patients. There was a significant difference in mastectomy weight between drain group patients (n=80, median: 730g) and no drain group patients (n=50, median: 424g) (p=<0.001). The mean cost for drain group patients was £639.77 whilst for the no drain group was £365.46, indicating a potential unit saving of £21944.93 over sixteen months. Length of stay was shorter in the no drain group (range: 1-2 days) than the drain group (range: 1-4 days). The presence or absence of drains did not influence complication rates, with no change in seroma interventions (p=0.803). Conclusions Managing simple mastectomy patients without a drain resulted in no increase in complications or subsequent interventions for seroma. Significant cost savings to both the hospital and to the patient can be achieved by omitting drain use. Routine use of drains in patients undergoing simple mastectomy ± SNB may be unnecessary and costly.
引言 乳房切除术后引流管的使用差异很大。本研究旨在确定单纯乳房切除术不使用引流管是否比使用引流管的相同手术成本更低，以及并发症是否存在差异。方法 收集了16个月内所有接受单纯乳房切除术±前哨淋巴结活检患者的前瞻性数据。外科医生在术中决定是否放置引流管。数据包括手术细节、乳房切除重量、住院时间和术后并发症。通过结合住院和随访预约的医院财务成本以及耗材成本来确定成本数据。结果 对119例患者进行了130例乳房切除术。引流管组患者（n = 80，中位数：730g）和无引流管组患者（n = 50，中位数：424g）的乳房切除重量存在显著差异（p = <0.001）。引流管组患者的平均成本为639.77英镑，而无引流管组为365.46英镑，表明在16个月内每个病例可能节省21944.93英镑。无引流管组的住院时间（范围：1 - 2天）比引流管组（范围：1 - 4天）短。引流管的使用与否不影响并发症发生率，血清肿干预无变化（p = 0.803）。结论 单纯乳房切除术患者不使用引流管不会增加并发症或血清肿的后续干预。省略引流管的使用可为医院和患者节省大量成本。对于接受单纯乳房切除术±前哨淋巴结活检的患者常规使用引流管可能是不必要且昂贵的。
