Lerch Aaron, Chau Anthony Minh Tien
Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Department of Neurosurgery, Mater Hospital Brisbane, South Brisbane, Australia.
Br J Neurosurg. 2024 Feb;38(1):3-11. doi: 10.1080/02688697.2023.2254833. Epub 2023 Sep 12.
Controversy remains with the use of post-operative subfascial drains for anterior cervical discectomy and fusion, with limited guidelines and a paucity of conclusive evidence. Thus, the aim of this meta-analysis was to analyse and collate an evidence summary to determine the efficacy of such drains.
A systematic search of Medline (2002-2022.11), PubMed (2003-2022.11), Scopus (2002-2022.11), Cochrane Library (2015-2022.11) databases and reference lists of articles was conducted as per Cochrane systematic reviews standards. All relevant RCTs and NRCTs were included in this study. Data was extracted in a standardised form and analysed with RevMan version 5.4.1. Bias was assessed with RoB2 tool for RCTs and ROBINS-E tool for NRCTs.
Two RCTs (136 patients) and five NRCTs (7563 patients) were included. These had a moderate to high risk of bias, except for one very high-risk article. Meta-analysis results showed no significant differences for post-operative haematoma ( = 0.31), surgical site infection ( = 0.84), take back to theatre ( = 0.27), length of stay ( = 0.34), and estimated blood loss ( = 0.09). Dysphagia ( = 0.002) and median operative time ( = 0.02) were significantly increased in the drain cohort.
The low quality of available data in the included studies is insufficient to estimate the effect of post-operative drains for elective spondylotic ACDF. The findings suggest that if the decision to leave a drain in is left to the surgeon, then there is no difference in the rates of POH, SSI, LOS, or take back to the theatre. The significant association of dysphagia and increased operative time with drains, and the non-significant trend towards increased EBL with drains, must be considered in the context in which procedures may influence the decision to place drains. The results could not be stratified by various confounders that affect the decision-making process, including the number of levels operated. Due to the decreased quality and amount of evidence available, large-scale RCTs that adequately account for confounders should be performed.
对于颈椎前路椎间盘切除融合术后使用筋膜下引流管仍存在争议，相关指南有限且确凿证据匮乏。因此，本荟萃分析的目的是分析和整理证据总结，以确定此类引流管的疗效。
按照Cochrane系统评价标准，对Medline（2002 - 2022.11）、PubMed（2003 - 2022.11）、Scopus（2002 - 2022.11）、Cochrane图书馆（2015 - 2022.11）数据库以及文章的参考文献列表进行系统检索。本研究纳入所有相关的随机对照试验（RCT）和非随机对照试验（NRCT）。数据以标准化形式提取，并使用RevMan 5.4.1版本进行分析。使用RoB2工具评估RCT的偏倚，使用ROBINS - E工具评估NRCT的偏倚。
纳入了两项RCT（136例患者）和五项NRCT（7563例患者）。除一篇高风险文章外，这些研究存在中度至高度偏倚风险。荟萃分析结果显示，术后血肿（比值比 = 0.31）、手术部位感染（比值比 = 0.84）、返回手术室（比值比 = 0.27）、住院时间（比值比 = 0.34）和估计失血量（比值比 = 0.09）方面无显著差异。引流管组吞咽困难（比值比 = 0.002）和中位手术时间（比值比 = 0.02）显著增加。
纳入研究中可用数据质量较低，不足以评估择期脊髓型颈椎病颈椎前路椎间盘切除融合术术后引流管的效果。研究结果表明，如果是否留置引流管由外科医生决定，那么术后血肿、手术部位感染、住院时间或返回手术室的发生率并无差异。在手术可能影响是否放置引流管决策的背景下，必须考虑吞咽困难和手术时间增加与引流管的显著关联，以及引流管导致估计失血量增加的不显著趋势。结果无法按影响决策过程的各种混杂因素进行分层，包括手术节段数量。由于现有证据质量和数量下降，应开展充分考虑混杂因素的大规模RCT。
