To drain or not to drain following carotid endarterectomy: a systematic review and meta-analysis
| Autor: | Marco Franchin, Claudio Corazzari, Ruth L. Bush, Nicola Rivolta, Gabriele Piffaretti, Walter Dorigo, Matteo Tozzi |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Decompression medicine.medical_treatment Decision Making Carotid endarterectomy Postoperative Hemorrhage 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine Humans Carotid Stenosis Endarterectomy Postoperative Care Endarterectomy Carotid Hematoma business.industry General Medicine Odds ratio Confidence interval Surgery Systematic review 030228 respiratory system Meta-analysis Drainage Cardiology and Cardiovascular Medicine business Complication Neck |
| Zdroj: | The Journal of Cardiovascular Surgery. 62 |
| ISSN: | 1827-191X 0021-9509 |
| DOI: | 10.23736/s0021-9509.21.11767-7 |
| Popis: | 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 This study is a systematic review and meta-analysis performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 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=0.02) 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. |
| Databáze: | OpenAIRE |
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