Drain or no drain after thyroid surgery? An evidence based audit

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Introduction: The routine use of drains in post-operative thyroid patients was found to have implications on patient length of stay (LOS) and cost in a level 1b study. In view of this, we assessed in our institution whether a change of practice towards the cessation of drain usage should be introduced from the routine use of drains in post-thyroidectomy. Furthermore, we assessed whether this change would have an effect on adverse events and cost effectiveness.

Materials and Methods: A prospective thyroid surgical database was setup. This comprised of two cohorts of patients: a pre-practice and post-practice change. A total of 109 patients were included in the study that underwent total thyroidectomy. Of these patients, 22 (20.2%) underwent total thyroidectomy (8 with drain; 14 no drain), 87 (79.8%) underwent partial thyroidectomy (24 with drain; 63 no drain). Additionally, patients were further stratified according to benign (n=69) and malignant (n=40) disease. The LOS, cost effectiveness and unexpected adverse events were analysed. Patients with post-operative hypocalcaemia were excluded from the study.

Results: No unexpected adverse events occurred in either cohort group. The average LOS for benign disease was longer with drain in-situ compared to without drain (2.47 days vs. 3.72 days respectively). For malignant disease this was an average LOS 4.33 days vs. 2.23 days. Overall, the combined results showed the mean number of days saved by not using a drain post-operatively was 1.53 days, amounting to 117.5 days saved. With a minimum cost of stay per night of £354, this equates to a total of £41 595 saved.

Conclusion: This study demonstrated the cessation of post-operative drain usage for uncomplicated thyroid surgery is beneficial for both the patient and the hospital. The LOS was reduced by 1.53 days without morbidity to the patient. Additionally, this provides substantial savings to the hospital which is applicable to the current economic climate.

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Read 1924 times Last modified on Tuesday, 10 December 2013 14:27

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