The utility of surgical drains in adult and pediatric posterior spinal fusion: systematic review and meta-analysis

Surgical drains are utilized in spinal surgery to reduce the incidence of epidural hematomas (EDHs) and to facilitate optimal wound healing. Despite their widespread use, there is a paucity of data to support their utility. The goal of this systematic review and meta-analysis is to compare the effect of using drains versus no drains on postoperative outcomes in adult and pediatric patients undergoing posterior spinal fusions for deformity or degenerative conditions. The following outcomes were assessed: SSIs, EDHs, reoperations, transfusions, and length of stay (LOS). A systematic review of the literature in databases was conducted for all relevant literature. Exclusion criteria included single level decompressions, minimally invasive fusions, anterior-only approaches, and any surgical procedures performed for tumor, trauma, and osteomyelitis. Forest plots for Odds Ratios (ORs) and Mean Differences (MDs) were generated using random effects model. The search identified 2,210 titles, of which 11 studies were chosen for final analysis. 5 studies involved pediatric patients, while 6 included adult patients. A total of 3293 patients were analyzed-2,060 had a drain, and 1,233 had no drain. There were no statistically significant differences in the ORs of SSIs, EDHs, reoperations, and transfusions. LOS in adults was higher in the Drain group (MD 1.36 days 95% CI 0.25 - 2.47). This meta-analysis found no benefit in surgical drains in posterior spinal fusion in reducing the incidence of SSI, EDH, and reoperation. Drains may be associated with longer LOS in the adult population. PROSPERO registration number: CRD42023417315.