Loon Muhammad Muaz, Mohamed Ebrahem H, Oliveira Souza Lima Sergio Rodrigo, Hassan Baran Dilshad, Abbas Tajammul
Surgery, Mayo Hospital, Lahore, PAK.
Spine Surgery, Egyptian Sugar and Integrated Industries Co. Medical Center, Cairo, EGY.
Cureus. 2024 Nov 10;16(11):e73364. doi: 10.7759/cureus.73364. eCollection 2024 Nov.
This systematic review assessed the comparative effectiveness of surgical drainage techniques and postoperative interventions in reducing complications across various surgical fields. We conducted a comprehensive search across multiple databases, including PubMed, MEDLINE, Embase, the Cochrane Library, and CINAHL, covering studies from January 2019 to September 2024. Ten randomized controlled trials met our inclusion criteria, focusing on human surgical patients and comparing outcomes such as seroma, hematoma, infection rates, and postoperative pain. Techniques such as pigtail catheters and vacuum sealing drainage (VSD) demonstrated statistically significant improvements in thoracic and orthopedic surgeries, reducing postoperative pain (effect size: 0.35, p < 0.05), pleural effusion (risk ratio: 0.68, p < 0.01), and hospital stays (mean difference: -2.5 days, p < 0.01), while also accelerating wound healing. However, inconsistent results were observed for hemostatic agents like topical gelatin-thrombin matrix sealant and polysaccharide agents, which did not consistently reduce complications in spinal and breast surgeries (effect size range: 0.10-0.20, p > 0.05). These findings suggest that drainage techniques should be tailored to specific surgical procedures and that the routine use of hemostatic agents requires more critical evaluation. Based on these insights, the review recommends prioritizing the use of pigtail catheters and VSD in appropriate contexts while further investigating the effectiveness of hemostatic agents in different surgical fields. This review underscores the need for additional long-term studies and personalized approaches to optimize drainage management in diverse patient populations. Overall, it provides clinicians with concrete recommendations and a framework for improving postoperative care and guiding clinical decision-making.
本系统评价评估了手术引流技术和术后干预措施在减少不同手术领域并发症方面的相对有效性。我们在多个数据库中进行了全面检索，包括PubMed、MEDLINE、Embase、Cochrane图书馆和CINAHL，涵盖2019年1月至2024年9月的研究。十项随机对照试验符合我们的纳入标准，重点关注接受手术的人类患者，并比较了血清肿、血肿、感染率和术后疼痛等结果。猪尾导管和负压封闭引流（VSD）等技术在胸外科和骨科手术中显示出统计学上的显著改善，减少了术后疼痛（效应大小：0.35，p<0.05）、胸腔积液（风险比：0.68，p<0.01）和住院时间（平均差异：-2.5天，p<0.01），同时还加速了伤口愈合。然而，对于局部明胶-凝血酶基质密封剂和多糖类止血剂等止血剂，观察到的结果不一致，它们在脊柱和乳腺手术中并不能持续减少并发症（效应大小范围：0.10-0.20，p>0.05）。这些发现表明，引流技术应根据特定的手术程序进行调整，止血剂的常规使用需要更严格的评估。基于这些见解，该评价建议在适当情况下优先使用猪尾导管和VSD，同时进一步研究止血剂在不同手术领域的有效性。本评价强调需要进行更多的长期研究和采用个性化方法，以优化不同患者群体的引流管理。总体而言，它为临床医生提供了具体建议和框架，以改善术后护理并指导临床决策。
