The Journal of Cardiovascular Surgery 2021 Apr 08

DOI: 10.23736/S0021-9509.21.11767-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

To drain or not to drain following carotid endarterectomy: a systematic review and meta-analysis

Nicola RIVOLTA ¹, Gabriele PIFFARETTI ¹ ✉, Claudio CORAZZARI ^{1, 2}, Ruth L. BUSH ³, Walter DORIGO ⁴, Matteo TOZZI ¹, Marco FRANCHIN ¹

¹ Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy; ² Cardiac Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy; ³ University of Houston College of Medicine, Houston, TX, USA; ⁴ Vascular Surgery, Department of Clinical and Experimental Medicine, University of Florence School of Medicine, Careggi University Teaching Hospital, Florence, Italy

INTRODUCTION: A postoperative neck hematoma can be a life-threatening complication after carotid endarterectomy necessitating urgent surgical decompression to avoid airway compromise. The practice of routine incisional drain placement is variable with few published studies evaluating the “to drain versus not to drain” approach. We conducted a systematic review and meta-analysis of the safety and efficacy of neck drain placement for prevention of neck hematoma requiring re-exploration for decompression.
EVIDENCE ACQUISITION: It was a systematic review and meta-analysis performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios with 95% confidence intervals were calculated for the outcome of surgical re-exploration for neck decompression among patients receiving or not receiving wound drainage.
EVIDENCE SYNTHESIS: We identified 5 studies for inclusion, comprising 48.297 patients with 19.832 (41.1%) patients receiving a drain after carotid endarterectomy. Patients in the drain group had a significantly higher re-exploration rate after carotid endarterectomy compared to those who did not receive a drainage (OR, 1.24, 95%CI: 1.03-1.49; p =.02) with no heterogeneity (I2 = 0%).
CONCLUSIONS: Routine drain placement does not offer complete protection against neck hematoma development and may give the surgeon a false sense of security in wound drainage. Thus, we conclude that drain placement following carotid endarterectomy should be selective, not routine.

KEY WORDS: Carotid endarterectomy; Drainage; Neck hematoma; Wound drainage; Wound hematoma