Wound drains following thyroid surgery

Kumarakrishnan Samraj; Kurinchi Selvan Gurusamy

doi:10.1002/14651858.CD006099.pub2

Drenajes de la herida después de la cirugía tiroidea

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios excluidos
estudios a la espera de valoración
otras referencias

De Salvo L, Razzetta F, Tassone U, Arezzo A, Mattioli FP. [The role of drainage and antibiotic prophylaxis in thyroid surgery]. Minerva Chirurgica 1998;53(11):895‐8.

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Referencias de los estudios excluidos de esta revisión

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estudios a la espera de valoración
otras referencias

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estudios a la espera de valoración

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

De Salvo 1998

Methods	Randomisation ‐ unclear Allocation concealment ‐unclear Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ Adequate
Participants	Country‐ Italy All thyroid operations (sub total thyroidectomy) except those with mediastinal extension and Basedow's disease Age range 19‐75 Number of females 62 Sample = 80
Interventions	Open drain compared with closed (suction)
Outcomes	Haematoma, Seroma Wound infection Number of dressing changes
Notes	Drain usage fixed ‐ 24 hrs
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Debry 1999

Methods	Randomisation ‐ by random number table. Allocation concealment ‐ sealed envelopes Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	Country ‐France All thyroid surgeries except those requiring cervical neck dissection Sample 100 Mean Age 46.5 Females 86 Age range n/a
Interventions	Suction drain compared with no drain
Outcomes	Infection/ haematoma Ultrasound in doubtful cases Hospital stay
Notes	Includes some patients with grave's disease
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Giovannini 1999

Methods	Randomisation‐ unclear Allocation concealment ‐ unclear Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up‐ adequate
Participants	Country‐ Italy Thyroid operations (44 Hemithyroidectomies and 100 thyroidectomies) Excluded: Malignant thyroid operations involving total thyroidectomy with neck dissection , coagulation disorders, Basedow,s disease and Basedow's Goitre Sample 144 Number of females 114 Age range n/a
Interventions	Suction drain versus no drain
Outcomes	Seroma / haematoma
Notes	Drain usage fixed (2 days)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Hurtado‐Lopez 2001

Methods	randomisation‐ random number table Allocation concealment ‐ sealed envelopes Blinding of care provider ‐ unclear Blinding of assessor‐ unclear Follow up ‐ adequate
Participants	All thyroid surgeries Total 150, 50 in each group Age range 15‐ 72
Interventions	Three groups: No drain, Penrose drain and suction drain
Outcomes	Haematoma/ seroma Reoperation Hospital Stay
Notes	Authors contacted and further data obtained.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Khanna 2005

Methods	Randomisation ‐ by computer generated random number table Allocation concealment ‐ sealed envelopes Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	94 patients undergoing 104 thyroid surgeries Re‐operative thyroids included Exclusion: those requiring cervical neck dissection Mean age 34.5 Age range 8‐60
Interventions	Suction drain compared with no drain
Outcomes	Ultrasound on day 1 and day 8 for collection Respiratory distress Wound collection Infection Tetany Tingling
Notes	Drain usage fixed‐ 48 hrs
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Lee 2006

Methods	Randomisation ‐ computer generated Allocation concealment‐ unclear Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	Participants: all thyroidectomies Excluded: Lateral cervical dissection and excision of surrounding soft tissues for large goitres, substernal goitres, Grave's disease Total number 198 Number of females 174 Mean age 47.6 Age range n/a
Interventions	Suction drain compared with no drain
Outcomes	Seroma / haematoma
Notes	Drain usage not fixed. Removed if less than 20 ml/24 hrs
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Peix 1992

Methods	Randomisation ‐ unclear Allocation concealment ‐sealed envelopes Blinding of participant ‐ unclear Blinding of care provider ‐ unclear Outcome assessors blinding‐ adequate Follow up‐adequate Power calculation done‐ power estimated to be 50% to detect a RR of 3 for complications, but at end of study. No sample size calculation before starting trial.
Participants	Country ‐ France sample 97 Mean age 43 Females 85 age less than 75 no previous neck surgery clinically and bischemically euthyroid thyroid surgery for excision of cold nodule Only unilateral lobectomies weighing less than 250 gms same surgeon Age range n/a
Interventions	Suction drain compared with no drain
Outcomes	Haematoma Hospital Stay
Notes	Drain removed 24‐ 48 hrs
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Pezzullo 2001

Methods	Randomisation unclear. Allocation concealment ‐sealed envelopes Blinding of care provider ‐ unclear Outcome assessors blinding‐ unclear Follow up ‐adequate
Participants	60 patients Country: Italy Mean Age: 45.7 Age range n/a Females 52 9 different surgeons ( 2 senior and 7 junior) Exclusion: Previous neck irradiation or surgery Both unilateral and bilateral operations
Interventions	Drain (Blake's) compared with no drain
Outcomes	Haemorrhage Seroma Hospital stay
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Schoretsanitis 1998

Methods	Randomisation ‐ by computer Allocation concealment‐adequate, third party Blinding of care provider ‐ unclear Blinding of assessor‐ unclear Follow up‐ adequate
Participants	Country ‐ Greece All thyroid operations Sample 200 Median age 52 Age range n/a Number of females 121
Interventions	Suction drain compared with no drain
Outcomes	Pain at 24 hrs by visual analogue scale 0 to 10. 24 hr analgesic requirement Reoperation Wound collection Wound infection
Notes	Drain usage 24‐48 hrs No prophylactic antibiotics Lymphatic discharge in 2 patients
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Schwarz 1996

Methods	Same as Willy 1998
Participants
Interventions
Outcomes
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Suslu 2006

Methods	Randomisation ‐ unclear Allocation concealment ‐ unclear Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up adequate
Participants	Age range n/a All thyroid surgeries, including recurrent surgery, Graves disease included. Sample 135 Age 34‐60 Exclusions: Neck dissections and mediastinal extensions
Interventions	Suction drain compared with no drain
Outcomes	Haematoma seroma Reoperation Hospital Stay Wound infection
Notes	Antibiotics used pre op
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Teboul 1992

Methods	Same as Peix 1992
Participants
Interventions
Outcomes
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Tubergen 2001

Methods	Randomisation ‐ unclear Allocation concealment ‐ sealed envelopes Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	Patients with thyroid nodule, clinically and biochemically euthyroid Sample 100 Age range 20‐82
Interventions	Suction drain compared with no suction
Outcomes	Wound collection as measured clinically Ultrasound on 3rd postop day and after discharge Reoperation for bleed Pain Hospital stay
Notes	Drain usage ‐ fixed (48 hrs)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Whilborg 1998

Methods	Randomisation ‐ unclear Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	Age range 10‐77 Median age 48 Sample 150
Interventions	Suction drain compared with no drain
Outcomes	Reoperation for haematoma Wound Infection Hospital stay
Notes	Surgeon forgot to randomise 3 patients 3 had sternotomy 2 had extensive cervical dissection 1 lymphatic leak settled after 18 days.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Willy 1998

Methods	Randomisation ‐ random number table. Allocation concealment‐ inadequate. Surgeon was aware of allocation before starting surgery (as envelopes were opened at start of operation). Blinding of care provider ‐ unclear Blinding of assessor ‐ unclear Follow up ‐ adequate
Participants	All bilateral operations (subtotal thyroidectomies) Total number 80 Number of females 51 Age range 20‐79 Exclusions: unilateral operations, coagulation disorders, previous neck operations
Interventions	High vacuum (Redon) compared with passive (Robinson) drain
Outcomes	Collection volume after removal of drains measured by ultrasound Hospital stay Reoperation/ aspiration of haematomas Total volume drained by either drains
Notes	Ciprofloxacin pre op Surgeon aware of group allocation before starting surgery
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Ayyash 1991	Includes parathyroid operations
Kristoffersson 1986	Includes parathyroid operations

Data and analyses

Open in table viewer

Comparison 1. Drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Reoperation Show forest plot	11	1436	Risk Ratio (M‐H, Fixed, 95% CI)	2.12 [0.77, 5.83]
Open in figure viewer Analysis 1.1 Comparison 1 Drain compared with no drain, Outcome 1 Reoperation.
1.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	3.02 [0.91, 10.06]
1.2 Only high quality studies	4	552	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.43]
2 Respiratory distress Show forest plot	3	435	Risk Ratio (M‐H, Fixed, 95% CI)	4.93 [0.24, 100.75]
Open in figure viewer Analysis 1.2 Comparison 1 Drain compared with no drain, Outcome 2 Respiratory distress.
3 Wound Infection Show forest plot	5	687	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.53, 4.83]
Open in figure viewer Analysis 1.3 Comparison 1 Drain compared with no drain, Outcome 3 Wound Infection.
3.1 Studies of poorer quality	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.25, 8.85]
3.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.85]
4 Collections needing aspiration/drainage without reoperation Show forest plot	10	1336	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.27, 0.97]
Open in figure viewer Analysis 1.4 Comparison 1 Drain compared with no drain, Outcome 4 Collections needing aspiration/drainage without reoperation.
4.1 Studies of poorer quality	6	784	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.13, 0.69]
4.2 Only high quality studies	4	552	Risk Ratio (M‐H, Fixed, 95% CI)	1.82 [0.51, 6.46]
5 Minor collections not requiring intervention. Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.68, 1.55]
Open in figure viewer Analysis 1.5 Comparison 1 Drain compared with no drain, Outcome 5 Minor collections not requiring intervention..
5.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.64, 1.64]
5.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.46, 2.38]
6 Pain (proportion) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [1.10, 4.23]
Open in figure viewer Analysis 1.6 Comparison 1 Drain compared with no drain, Outcome 6 Pain (proportion).
7 Pain Severity Show forest plot	1	200	Mean Difference (IV, Fixed, 95% CI)	2.60 [2.21, 2.99]
Open in figure viewer Analysis 1.7 Comparison 1 Drain compared with no drain, Outcome 7 Pain Severity.
8 Hospital Stay Show forest plot	8	1001	Mean Difference (IV, Random, 95% CI)	1.18 [0.73, 1.63]
Open in figure viewer Analysis 1.8 Comparison 1 Drain compared with no drain, Outcome 8 Hospital Stay.
8.1 Studies of poorer quality	5	549	Mean Difference (IV, Random, 95% CI)	1.09 [0.59, 1.59]
8.2 Only high quality studies	3	452	Mean Difference (IV, Random, 95% CI)	1.27 [0.43, 2.12]

Open in table viewer

Comparison 2. Suction drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Reoperation Show forest plot	11	1386	Risk Ratio (M‐H, Fixed, 95% CI)	2.12 [0.77, 5.83]
Open in figure viewer Analysis 2.1 Comparison 2 Suction drain compared with no drain, Outcome 1 Reoperation.
1.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	3.02 [0.91, 10.06]
1.2 only high quality studies	4	502	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.43]
2 Respiratory distress Show forest plot	3	435	Risk Ratio (M‐H, Fixed, 95% CI)	4.93 [0.24, 100.75]
Open in figure viewer Analysis 2.2 Comparison 2 Suction drain compared with no drain, Outcome 2 Respiratory distress.
3 Wound Infection Show forest plot	5	687	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.53, 4.83]
Open in figure viewer Analysis 2.3 Comparison 2 Suction drain compared with no drain, Outcome 3 Wound Infection.
3.1 Studies of poorer quality	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.25, 8.85]
3.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.85]
4 Collections needing aspiration/drainage without reoperation Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.25, 0.92]
Open in figure viewer Analysis 2.4 Comparison 2 Suction drain compared with no drain, Outcome 4 Collections needing aspiration/drainage without reoperation.
4.1 Studies of poorer quality	6	784	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.13, 0.69]
4.2 Only high quality studies	4	502	Risk Ratio (M‐H, Fixed, 95% CI)	1.78 [0.44, 7.17]
5 Minor collections not requiring intervention. Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.68, 1.55]
Open in figure viewer Analysis 2.5 Comparison 2 Suction drain compared with no drain, Outcome 5 Minor collections not requiring intervention..
5.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.64, 1.64]
5.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.46, 2.38]
6 Pain (proportion) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [1.10, 4.23]
Open in figure viewer Analysis 2.6 Comparison 2 Suction drain compared with no drain, Outcome 6 Pain (proportion).
7 Pain Severity Show forest plot	1	200	Mean Difference (IV, Fixed, 95% CI)	2.60 [2.21, 2.99]
Open in figure viewer Analysis 2.7 Comparison 2 Suction drain compared with no drain, Outcome 7 Pain Severity.
8 Hospital Stay Show forest plot	8	951	Mean Difference (IV, Random, 95% CI)	1.20 [0.77, 1.63]
Open in figure viewer Analysis 2.8 Comparison 2 Suction drain compared with no drain, Outcome 8 Hospital Stay.
8.1 Studies of poorer quality	5	549	Mean Difference (IV, Random, 95% CI)	1.09 [0.59, 1.59]
8.2 Only high quality studies	3	402	Mean Difference (IV, Random, 95% CI)	1.33 [0.60, 2.06]

Open in table viewer

Comparison 3. Open drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Collections needing aspiration/drainage without reoperation Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.26, 8.60]
Open in figure viewer Analysis 3.1 Comparison 3 Open drain compared with no drain, Outcome 1 Collections needing aspiration/drainage without reoperation.
2 Hospital Stay Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	0.60 [0.28, 0.92]
Open in figure viewer Analysis 3.2 Comparison 3 Open drain compared with no drain, Outcome 2 Hospital Stay.

Open in table viewer

Comparison 4. Suction drain compared with open drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Wound Infection Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 3.07]
Open in figure viewer Analysis 4.1 Comparison 4 Suction drain compared with open drain, Outcome 1 Wound Infection.
2 Collections needing aspiration/drainage without reoperation Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.12, 3.82]
Open in figure viewer Analysis 4.2 Comparison 4 Suction drain compared with open drain, Outcome 2 Collections needing aspiration/drainage without reoperation.
3 Minor collections not requiring intervention. Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.10, 2.58]
Open in figure viewer Analysis 4.3 Comparison 4 Suction drain compared with open drain, Outcome 3 Minor collections not requiring intervention..
4 Hospital Stay Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	0.22 [‐0.25, 0.69]
Open in figure viewer Analysis 4.4 Comparison 4 Suction drain compared with open drain, Outcome 4 Hospital Stay.

Figure 1

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Analysis 1.1

Comparison 1 Drain compared with no drain, Outcome 1 Reoperation.

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Analysis 1.2

Comparison 1 Drain compared with no drain, Outcome 2 Respiratory distress.

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Analysis 1.3

Comparison 1 Drain compared with no drain, Outcome 3 Wound Infection.

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Analysis 1.4

Comparison 1 Drain compared with no drain, Outcome 4 Collections needing aspiration/drainage without reoperation.

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Analysis 1.5

Comparison 1 Drain compared with no drain, Outcome 5 Minor collections not requiring intervention..

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Analysis 1.6

Comparison 1 Drain compared with no drain, Outcome 6 Pain (proportion).

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Analysis 1.7

Comparison 1 Drain compared with no drain, Outcome 7 Pain Severity.

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Analysis 1.8

Comparison 1 Drain compared with no drain, Outcome 8 Hospital Stay.

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Analysis 2.1

Comparison 2 Suction drain compared with no drain, Outcome 1 Reoperation.

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Analysis 2.2

Comparison 2 Suction drain compared with no drain, Outcome 2 Respiratory distress.

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Analysis 2.3

Comparison 2 Suction drain compared with no drain, Outcome 3 Wound Infection.

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Analysis 2.4

Comparison 2 Suction drain compared with no drain, Outcome 4 Collections needing aspiration/drainage without reoperation.

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Analysis 2.5

Comparison 2 Suction drain compared with no drain, Outcome 5 Minor collections not requiring intervention..

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Analysis 2.6

Comparison 2 Suction drain compared with no drain, Outcome 6 Pain (proportion).

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Analysis 2.7

Comparison 2 Suction drain compared with no drain, Outcome 7 Pain Severity.

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Analysis 2.8

Comparison 2 Suction drain compared with no drain, Outcome 8 Hospital Stay.

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Analysis 3.1

Comparison 3 Open drain compared with no drain, Outcome 1 Collections needing aspiration/drainage without reoperation.

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Analysis 3.2

Comparison 3 Open drain compared with no drain, Outcome 2 Hospital Stay.

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Analysis 4.1

Comparison 4 Suction drain compared with open drain, Outcome 1 Wound Infection.

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Analysis 4.2

Comparison 4 Suction drain compared with open drain, Outcome 2 Collections needing aspiration/drainage without reoperation.

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Analysis 4.3

Comparison 4 Suction drain compared with open drain, Outcome 3 Minor collections not requiring intervention..

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Analysis 4.4

Comparison 4 Suction drain compared with open drain, Outcome 4 Hospital Stay.

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Table 1. Search Strategy

Database	Strategy
Ovid MEDLINE	1 exp Thyroid Gland/ 2 exp Thyroid Neoplasms/ 3 exp Thyroidectomy/ 4 exp Graves Disease/ 5 exp Goiter/ 6 exp Hyperthyroidism/ 7 (thyroid or thyroidectom$ or hemithyroidectom$ or hyperthyroid$ or graves disease or goitre$).ti,ab. 8 or/1‐7 9 exp Drainage/ 10 exp Suction/ 11 exp Catheterization/ 12 (drain$1 or drainage or catheter$).ti,ab. 13 or/9‐12 14 8 and 13 15 RANDOMIZED CONTROLLED TRIAL.pt. 16 CONTROLLED CLINICAL TRIAL.pt. 17 RANDOMIZED CONTROLLED TRIALS.sh. 18 RANDOM ALLOCATION.sh. 19 DOUBLE BLIND METHOD.sh. 20 SINGLE‐BLIND METHOD.sh. 21 or/15‐20 22 Animals/ 23 Humans/ 24 22 not 23 25 21 not 24 26 CLINICAL TRIAL.pt. 27 exp Clinical Trials/ 28 (clin$ adj25 trial$).ti,ab. 29 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. 30 PLACEBOS.sh. 31 placebo$.ti,ab. 32 random$.ti,ab. 33 or/26‐32 34 33 not 24 35 25 or 34 36 14 and 35
Ovid EMBASE	1 exp Thyroid Gland/ 2 exp Thyroid Cancer/ 3 exp Thyroidectomy/ 4 exp Graves Disease/ 5 exp Goiter/ 6 exp Hyperthyroidism/ 7 (thyroid or thyroidectom$ or hemithyroidectom$ or hyperthyroid$ or graves disease or goitre$).ti,ab. 8 or/1‐7 9 exp drain/ 10 exp surgical drainage/ 11 exp catheter/ 12 (drain$1 or drainage or catheter$).ti,ab. 13 or/9‐12 14 8 and 13 15 exp Clinical trial/ 16 Randomized controlled trial/ 17 Randomization/ 18 Single blind procedure/ 19 Double blind procedure/ 20 Crossover procedure/ 21 Placebo/ 22 Randomi?ed controlled trial$.tw. 23 RCT.tw. 24 Random allocation.tw. 25 Randomly allocated.tw. 26 Allocated randomly.tw. 27 (allocated adj2 random).tw. 28 Single blind$.tw. 29 Double blind$.tw. 30 ((treble or triple) adj blind$).tw. 31 Placebo$.tw. 32 Prospective study/ 33 or/15‐32 34 Case study/ 35 Case report.tw. 36 Abstract report/ or letter/ 37 or/34‐36 38 33 not 37 39 animal/ 40 human/ 41 39 not 40 42 38 not 41 43 14 and 42
WIS Online CENTRAL	1 MeSH descriptor Thyroid Gland explode all trees 2 MeSH descriptor Thyroid Neoplasms explode all trees 3 MeSH descriptor Thyroidectomy explode all trees 4 MeSH descriptor Graves Disease explode all trees 5 MeSH descriptor Goiter explode all trees 6 MeSH descriptor Hyperthyroidism explode all trees 7 (thyroid or thyroidectom* or hemithyroidectom* or hyperthyroid* or “graves disease” or goitre*):ti,ab,kw 8 (1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7) 9 MeSH descriptor Drainage explode all trees 10 MeSH descriptor Suction explode all trees 11 MeSH descriptor Catheterization explode all trees 12 (drain or drains or drainage or catheter$):ti,ab,kw 13 (9 OR 10 OR 11 OR 12) 14 (8 AND 13)
Ovid CINAHL	1 exp Thyroid Gland/ 2 exp Thyroid Neoplasms/ 3 exp Thyroidectomy/ 4 exp Graves Disease/ 5 exp Goiter/ 6 exp Hyperthyroidism/ 7 (thyroid or thyroidectom$ or hemithyroidectom$ or hyperthyroid$ or graves disease or goitre$).ti,ab. 8 or/1‐7 9 exp Drainage/ 10 exp Suction/ 11 exp Catheterization/ 12 exp Catheters/ 13 (drain$1 or drainage or catheter$).ti,ab. 14 or/9‐13 15 8 and 14 16 exp clinical trials/ 17 Clinical trial.pt. 18 (clinic$ adj trial$1).tw. 19 ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$3 or mask$3)).tw. 20 Randomi?ed control$ trial$.tw. 21 Random assignment/ 22 Random$ allocat$.tw. 23 Allocat$ random$.tw. 24 Placebos/ 25 placebo$.tw. 26 or/16‐25 27 15 and 26

Table 1. Search Strategy

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Comparison 1. Drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Reoperation Show forest plot	11	1436	Risk Ratio (M‐H, Fixed, 95% CI)	2.12 [0.77, 5.83]

1.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	3.02 [0.91, 10.06]
1.2 Only high quality studies	4	552	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.43]
2 Respiratory distress Show forest plot	3	435	Risk Ratio (M‐H, Fixed, 95% CI)	4.93 [0.24, 100.75]

3 Wound Infection Show forest plot	5	687	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.53, 4.83]

3.1 Studies of poorer quality	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.25, 8.85]
3.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.85]
4 Collections needing aspiration/drainage without reoperation Show forest plot	10	1336	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.27, 0.97]

4.1 Studies of poorer quality	6	784	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.13, 0.69]
4.2 Only high quality studies	4	552	Risk Ratio (M‐H, Fixed, 95% CI)	1.82 [0.51, 6.46]
5 Minor collections not requiring intervention. Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.68, 1.55]

5.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.64, 1.64]
5.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.46, 2.38]
6 Pain (proportion) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [1.10, 4.23]

7 Pain Severity Show forest plot	1	200	Mean Difference (IV, Fixed, 95% CI)	2.60 [2.21, 2.99]

8 Hospital Stay Show forest plot	8	1001	Mean Difference (IV, Random, 95% CI)	1.18 [0.73, 1.63]

8.1 Studies of poorer quality	5	549	Mean Difference (IV, Random, 95% CI)	1.09 [0.59, 1.59]
8.2 Only high quality studies	3	452	Mean Difference (IV, Random, 95% CI)	1.27 [0.43, 2.12]

Comparison 1. Drain compared with no drain

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Comparison 2. Suction drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Reoperation Show forest plot	11	1386	Risk Ratio (M‐H, Fixed, 95% CI)	2.12 [0.77, 5.83]

1.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	3.02 [0.91, 10.06]
1.2 only high quality studies	4	502	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.05, 5.43]
2 Respiratory distress Show forest plot	3	435	Risk Ratio (M‐H, Fixed, 95% CI)	4.93 [0.24, 100.75]

3 Wound Infection Show forest plot	5	687	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.53, 4.83]

3.1 Studies of poorer quality	2	285	Risk Ratio (M‐H, Fixed, 95% CI)	1.49 [0.25, 8.85]
3.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.85]
4 Collections needing aspiration/drainage without reoperation Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.25, 0.92]

4.1 Studies of poorer quality	6	784	Risk Ratio (M‐H, Fixed, 95% CI)	0.31 [0.13, 0.69]
4.2 Only high quality studies	4	502	Risk Ratio (M‐H, Fixed, 95% CI)	1.78 [0.44, 7.17]
5 Minor collections not requiring intervention. Show forest plot	10	1286	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.68, 1.55]

5.1 Studies of poorer quality	7	884	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.64, 1.64]
5.2 Only high quality studies	3	402	Risk Ratio (M‐H, Fixed, 95% CI)	1.05 [0.46, 2.38]
6 Pain (proportion) Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [1.10, 4.23]

7 Pain Severity Show forest plot	1	200	Mean Difference (IV, Fixed, 95% CI)	2.60 [2.21, 2.99]

8 Hospital Stay Show forest plot	8	951	Mean Difference (IV, Random, 95% CI)	1.20 [0.77, 1.63]

8.1 Studies of poorer quality	5	549	Mean Difference (IV, Random, 95% CI)	1.09 [0.59, 1.59]
8.2 Only high quality studies	3	402	Mean Difference (IV, Random, 95% CI)	1.33 [0.60, 2.06]

Comparison 2. Suction drain compared with no drain

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Comparison 3. Open drain compared with no drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Collections needing aspiration/drainage without reoperation Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.26, 8.60]

2 Hospital Stay Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	0.60 [0.28, 0.92]

Comparison 3. Open drain compared with no drain

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Comparison 4. Suction drain compared with open drain

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Wound Infection Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.04, 3.07]

2 Collections needing aspiration/drainage without reoperation Show forest plot	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.12, 3.82]

3 Minor collections not requiring intervention. Show forest plot	1	80	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.10, 2.58]

4 Hospital Stay Show forest plot	1	100	Mean Difference (IV, Fixed, 95% CI)	0.22 [‐0.25, 0.69]

Comparison 4. Suction drain compared with open drain

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Referencias

Referencias de los estudios incluidos en esta revisión

De Salvo 1998 {published data only}

Debry 1999 {published data only}

Giovannini 1999 {published data only}

Hurtado‐Lopez 2001 {published data only}

Khanna 2005 {published data only}

Lee 2006 {published data only}

Peix 1992 {published data only}

Pezzullo 2001 {published data only}

Schoretsanitis 1998 {published data only}

Schwarz 1996 {published data only}

Suslu 2006 {published data only}

Teboul 1992 {published data only}

Tubergen 2001 {published data only}

Whilborg 1998 {published data only}

Willy 1998 {published data only}

Referencias de los estudios excluidos de esta revisión

Ayyash 1991 {published data only}

Kristoffersson 1986 {published data only}

Referencias de los estudios en espera de evaluación

Mok 1992 {published data only}

Referencias adicionales

Abbas 2001

Affleck 2003

Ardito 1999

Brander 1991

Coello 1997

Collis 2005

Coress 2005

Corsten 2005

Dackiw 2004

Daou 1997

DeMets 1987

DerSimonian 1986

Egger 1997

Ernst 1997

Farquharson 2005

Fredrickson 1998

Friguglietti 2003

Gavilán 2002

Healy 1989

HES 2006

Higgins 2002

Higgins 2005

Hollis 1999

Horan 1992

Huang 2005

Hurtado‐Lopez 2002

Karayacin 1997

Kjaergard 2001

Knudsen 2000

Macaskill 2001

Mannell 1989

Martis 1971

Miccoli 2004

Moher 1998

Okeke 2005

Palestini 2005

Parker 2001

Pino 2004

Pothier 2005

Riehl 1995

Rios 2005

Rosato 2004

Sanabria 2007

Schulz 1995

Scott‐Coombes 2005

Shaha 1993

Shaha 1994

Shaheen 1997

SIGN

SIGN 2006

Soleto 2003

Tabaqchali 1999

Teng 2002

Urbach 1999

Characteristics of studies