Thyroidectomy Bed Drainage Timing Is Volume-Dependent

Surgical drains can be removed following thyroid surgery once the volume of the fluid drained is reduced and is clear, according to a new study.

Researchers at the Nagasaki University Graduate School of Biomedical Sciences (Japan) conducted a retrospective study of 249 patients who underwent thyroid surgery, in order to evaluate the chronological changes in the amount of drainage fluid and to establish standard indications for the drain to be removed. The patients were divided into four groups: a Graves’ group, a non-dissection group, a central-dissection group, and a lateral-dissection group. The amount of drainage was measured every 6 hours, and the drain was removed postoperatively when the drainage decreased in amount and contained serous fluid after a meal.

The results showed that in all four groups, the most drainage occurred in the first six hours after surgery. The total amount of drainage from the operation to the time of drain removal was significantly higher in Graves’ group and in the lateral-dissection group than in the other two groups. The median wound drainage significantly decreased from 12–18 hours after surgery in all four groups. In the lateral-dissection group, the wound drainage significantly decreased again in the first 24–30 hours. The study was published in the January 2014 issue of Surgery Today.

“The findings of this study suggest that drains can be removed postoperatively if the drainage was less than 15 mL during a 6-hour period, and contain serous fluid,” concluded lead author Shigeki Minami, MD, PhD, and colleagues of the department of surgery and the department of global health, medicine and welfare.

Although drainage of the thyroidectomy bed is not an evidenced-based practice, most surgeons still employ routine drainage with an effort to monitor postoperative bleeding. Several studies, however, have indicated that not only is it not effective in decreasing the rate of postoperative complications after thyroid surgery, it actually causes a prolonged hospital stay and may lead to surgical site infection (SSI).

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Nagasaki University Graduate School of Biomedical Sciences