Oliveira Almeida Luiz Henrique, La Banca Vitor, Matsumoto Octavio, Steven de Sá Arthur, Palagi Viganó Ana Victória, Kalman Gabriel, Gonzalez Felipe Fernandes, Vieira Lima Guilherme Henrique, Murachovsky Joel, Ikemoto Roberto Yukio
Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina do ABC (FMABC), Santo André, Brazil.
Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, Brazil.
JSES Int. 2025 Apr 4;9(4):1266-1273. doi: 10.1016/j.jseint.2025.03.007. eCollection 2025 Jul.
Total shoulder replacement, including both anatomic and reverse procedures are one of the treatment options for shoulder arthritis and proximal humerus fractures, with consistently favorable outcomes in terms of pain relief and function improvement. During surgery, some surgeons prefer to place suction drains in the deep tissue to prevent hematomas or seromas, thereby reducing risks like wound dehiscence and infections. However, the routine use of suction drains in other orthopedic surgeries, such as hip and knee arthroplasty, has been questioned, with studies suggesting they may lead to extended hospital stays and increased need for transfusions without significantly reducing complications. Given the conflicting evidence in the literature about suction drains in shoulder arthroplasty, this study aims to evaluate their efficacy in reducing complications and in consequence the need for hospital stay and reoperations.
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The inclusion criteria encompassed studies comparing outcomes of patients undergoing shoulder arthroplasty (anatomic or reverse) with and without suction drains. Databases such as PubMed, Lilacs, Cochrane Library, and Scopus were searched, with no restrictions on language or publication date. Data extraction was performed for duration of hospital stay, transfusions, infections, wound dehiscence, reoperations, and hemoglobin changes. Meta-analyses were conducted using a random-effects model for mean differences (MDs) and odds ratios (ORs).
Six studies with a total of 22,710 patients were included. The mean patient age was 68.8 years, with a slight female predominance. Anatomic and reverse shoulder arthroplasties were both commonly performed. There was no significant difference in hospital stay (MD: 8.78 hours), infection rates (OR: 0.64; 95% confidence intervals (CI): 0.30-1.35), or reoperation rates (OR: 1.62; 95% CI: 0.16-16.23) between patients with drains and those without. However, hemoglobin loss was significantly greater in the drain group (MD: 0.31; 95% CI: 0.02-0.60).
The use of suction drains in shoulder arthroplasty does not significantly reduce infection or wound-related complications and is associated with increased hemoglobin loss. These findings suggest that the routine use of drains in shoulder arthroplasty may not provide tangible benefits and should be reconsidered to optimize patient outcomes.
全肩关节置换术，包括解剖型和反置型手术，是治疗肩关节关节炎和肱骨近端骨折的选择之一，在缓解疼痛和改善功能方面一直有着良好的效果。在手术过程中，一些外科医生倾向于在深部组织放置引流管以防止血肿或血清肿，从而降低伤口裂开和感染等风险。然而，在其他骨科手术中，如髋关节和膝关节置换术，常规使用引流管受到了质疑，研究表明它们可能导致住院时间延长和输血需求增加，而不会显著降低并发症。鉴于文献中关于肩关节置换术中引流管的证据相互矛盾，本研究旨在评估其在减少并发症以及由此导致的住院需求和再次手术方面的疗效。
本系统评价遵循系统评价和Meta分析的首选报告项目指南。纳入标准包括比较接受有或无引流管的肩关节置换术（解剖型或反置型）患者结局的研究。检索了PubMed、Lilacs、Cochrane图书馆和Scopus等数据库，对语言或出版日期没有限制。对住院时间、输血情况、感染、伤口裂开、再次手术以及血红蛋白变化进行数据提取。使用随机效应模型对均值差（MDs）和比值比（ORs）进行Meta分析。
纳入了6项研究，共22710例患者。患者平均年龄为68.8岁，女性略占优势。解剖型和反置型肩关节置换术均较为常见。有引流管和无引流管的患者在住院时间（MD：8.78小时）、感染率（OR：0.64；95%置信区间（CI）：0.30 - 1.35）或再次手术率（OR：1.62；95% CI：0.16 - 16.23）方面没有显著差异。然而，引流管组的血红蛋白损失明显更大（MD：0.31；95% CI：0.02 - 0.60）。
肩关节置换术中使用引流管并不能显著降低感染或与伤口相关的并发症，且与血红蛋白损失增加有关。这些发现表明，肩关节置换术中常规使用引流管可能无法带来切实益处，应重新考虑以优化患者结局。
