When should axillary drains be removed? A meta-analysis of time-limited versus volume controlled strategies for timing of drain removal following axillary lymphadenectomy

Publication date: Available online 5 October 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): David R. Thomson, Alexander E.J. Trevatt, Dominic Furniss
BackgroundDespite numerous studies over the past few decades, the optimum strategy for deciding when to remove drains following axillary lymphadenectomy remains unknown. This meta-analysis aims to compare time-limited and volume-controlled strategies for drain removal.Methods584 titles were identified following a systematic literature search of EMBASE, MEDLINE, Cinahl and the Cochrane library; six met our eligibility criteria. Data were extracted and independently verified by two authors. Time-limited drain removal was defined as drain removal at <5 days; volume-controlled strategies ranged from <20ml to <50ml/24h.ResultsIn all studies the time-limited approach resulted in earlier drain removal. Development of a seroma is 2.54 times more likely with early drain removal (Mantel-Haenszel Fixed Odds Ratio (OR) 2.54, p<0.00001). However, there is no difference in infection rates between early and late drain removal (OR=1.07, p=0.76).ConclusionsThis meta-analysis demonstrates that a strategy of early drain removal following axillary lymphadenectomy is safe,with no difference in infection rate, however, the incidence of seroma is significantly higher, which may necessitate more demanding outpatient care. There is a need for further well-designed clinical trials to address the clinical equipoise within this common area of surgical practice.



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