Publication: Vacuum drains vs passive drains vs no drains in decompressive craniectomies – A randomized controlled trial on subgaleal drain complication rates
Date
2021
Authors
Ee, Sam Jo
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Abstract
Introduction: Subgaleal drains are generally deemed necessary for cranial surgeries including decompressive craniectomies(DC) to avoid excessive post-operative subgaleal hematoma (SGH) formation but these drains maybe associated with other complications. This study aims to assess complication rates, functional outcome and mortality in patients utilizing vacuum drains(VD), passive drains(PD) and no drains(ND). Methods: This was a triple blinded randomized controlled trial involving 78 patients requiring DC which were equally randomized into the 3 different drain groups. The primary outcome was SGH thickness. Secondary outcomes of SGH volume, new remote hematomas, post-craniectomy hydrocephalus (PCH), modified Rankin Scale(mRS), mortality rates and their associated risk factors were studied as well. Results: There was no difference in SGH thickness between the 3 drain types (p=0.171). The mean SGH volume and new remote hematoma rate was not significantly different (p=0.320 and p=0.647 respectively). Only 1 patient in the VD group required re-surgery to evacuate SGH. 58 patients survived at least 60 days after DC, 7 of them (12.1%) developed PCH with insignificant difference between groups(p=0.083). In the univariate and multivariate analysis, VD group had better mRS (p=0.011) and mortality rates (p=0.032). In the subgroup analysis of 49 TBI patients, mean SGH thickness of VD group was significantly less than PD and ND group but this did not improve outcomes (p=0.022). Conclusion: There was no difference in SGH thickness, SGH volume, rates of PCH or new remote hematomas in all types of drain. However VD may have an advantage with regards to mRS, mortality rates, and lower SGH amounts in TBI.
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Keywords
subgaleal drains , subgaleal hematoma