Background Drainage tube should be used after posterior lumbar surgery to prevent complications such as postoperative epidural hematoma, neurological dysfunction, and delayed incision healing by traditional view. Enhanced recovery after surgery (ERAS) suggests that a series of measures should be adopted to reduce stress to promote recovery of surgical patients, including avoiding unnecessary drainage placement.
Objective To investigate the application value and conditions of non-drainage after single-level lumbar open surgery under the guidance of ERAS.
Methods Patients who needed single-segment open lumbar surgery from December 2020 to April 2021 in the Department of Spine Surgery, the Seventh Medical Center of Chinese PLA General Hospital were selected. Adequate hemostasis was performed during the operation. The incision was observed, which was soaked in 0.9% sodium chloride injection (normal saline, NS) before suture. If the bottom of the surgical field could be seen through the clear NS, the patient was included in the non-drainage group, otherwise she/he was included in the drainage group. The perioperative complications, the difference of red blood cell count (RBC), hemoglobin (Hb) before and 3 days after operation, Pittsburgh sleep quality index score (PSQI) and self-rating anxiety scale score (SAS) before and 7 days after operation were compared between the two groups. Visual analogue score (VAS) of lumbocrural pain, Oswestry’s dysfunction score (ODI) at different time points were evaluated. Time-to-ambulation and the score of comfort satisfaction and other indexes were also analyzed.
Results Totally 63 patients were included, of whom 30 cases were in the non-drainage group and 33 cases in the drainage group. There was no statistical difference in gender, age composition, operation type composition, operation blood loss and operation duration between the two groups. No postoperative complication occurred in the non-drainage group, however, 3 cases had postoperative complications in the drainage group, including 1 case of postoperative lumbocrural pain aggravated with lower limbs dysfunction and requiring a second operation, 1 case of postoperative drainage tube inadvertent removal, 1 case of postoperative urinary tract infection. In terms of laboratory indicators, with consistent preoperative baseline levels, there were no statistically significant differences in postoperative WBC, GC, RBC, Hb, and CRP between the two groups (P>0.05). However, there was a statistically significant difference in erythrocyte sedimentation rate (ESR) changes between the two groups (P<0.05), indicating a more pronounced increase in ESR during the perioperative period in the drain placement group. The perioperative blood loss was more in the drainage group. There were no significant differences in VAS, ODI, PSQI and SAS between the two groups (P>0.05). The time-to-ambulation in the non-drainage group was earlier than that in the drainage group (MIQR: 3 2 - 4 d vs 4 3 - 5 d, P=0.011). The score of comfort satisfaction in the non-drainage group was significantly higher than that in the drainage group (6.90 ± 1.86 vs 5.30 ± 2.27, P=0.004).
Conclusion The operation related to posterior lumbar single segment, open approach and internal fixation with no drainage is safe and feasible under the premise of sufficient hemostasis and exclusion of related postoperative complications, which can be adopted to accelerate the rehabilitation of spinal surgery patients, promote the early postoperative movement of patients, and improve patients’ score of comfort satisfaction.
DownLoad: