Practice variations, trends, and outcomes of drain use in thyroidectomy: A NSQIP study

• Published in: The American journal of surgery p. 115998
• Main Authors: Memeh, Kelvin, Abou Azar, Sara, Afolaranmi, Oluwasegun, Vaghaiwalla, Tanaz M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 04-10-2024
• Subjects: Drain; Postoperative neck hematoma; Thyroid surgery; Thyroidectomy; Postoperative neck hematoma; Drain; Thyroid surgery; Thyroidectomy
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115998

The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy.
This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016–2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)–primary outcome, and length-of-stay (LOS)–secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses.
Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91–3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51–10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05).
Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR.
•Drain use after thyroidectomy is associated with increased post-operative length of stay.•Drain use after thyroidectomy had no significant effect on postoperative neck hematoma.•Drain use increased year-over-year for concomitant neck dissections.•Practice variation for drain after thyroid surgery use persist across surgical specialties.•There is a downtrend in year-over-year odds of drain use after thyroidectomy across specialties.