Wound drains following thyroid surgery

Kumarakrishnan Samraj; Kurinchi Selvan Gurusamy

doi:10.1002/14651858.CD006099.pub2

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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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