Risk–benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary

Abstract
Study design Systematic review, meta-analysis, evidence synthesis.
Objectives To analyse the literature evidence available to support the usage of wound drain in various scenarios of spine
surgery and provide an evidence summary on the surgical practice.Materials and methods We conducted independent and duplicate electronic database searches adhering to PRISMA guide-lines in PubMed, Embase, and Cochrane Library till April 2020. Quality appraisal was done as per Cochrane ROB tool,
and evidence synthesis was done as per GRADE approach. Five domains of spine surgery with associated key questions
were identifed. Evidence tables were generated for each question and critical appraisal done as per the GRADE approach.
Results Twenty-three studies (9—RCTs, 4—prospective studies, 10—retrospective studies) were included. Analysis of studies in cervical spine either by anterior or posterior approach and single/multilevel thoracolumbar spinal surgeries did
not show any evidence of reduction in surgical site infection (SSI) or haematoma formation with the use of drain. Deformity
correction surgeries and surgeries done for trauma or tumour involving spine also did not fnd any added beneft from the
use of wound drains despite increasing the total blood loss.
Conclusion Evidence from this review suggests that routine use of drain in various domains of spine surgery does not reduce
the risk of SSI and their absence did not increase the risk of haematoma formation. The current best evidence is presented
with its limitations. High-quality studies to address their use in spine surgeries in cervical, trauma, and tumour domains are
required to further strengthen the evidence synthesised from available literature.