Closed-suction drains are routinely used by most head and neck surgeons after selective lateral neck dissections (SLNDs). A recent survey of more than 360 head and neck surgeons found that more than 60% use a criterion of less than 30 mL of output for 24 hours for removal. In this first ever prospective, single-blinded, randomised clinical trial authors compared drain output of 100ml or less with 30ml or less over 24 hours as the main criterion for drain removal after SLND.
Thirty-two patients after SLNDs were randomised to the 100-mL group and 35 were randomised to the 30-mL group. No meaningful differences in preoperative characteristics were noted between groups. Seromas developed equally in both groups (two in each group). The 100-mL group had a 1.87-day reduction in mean hospital length of stay.
Until the present study, little evidence has been available to guide the optimal drain removal strategy. The clinical decision for drain removal often depends on the preference and training of the surgeon. Because a single additional day in the hospital can cost a lot to the patient or the health authorities, any change in practice patterns that can reduce more than one hospital day is clinically meaningful. A volume threshold for drain removal of 100 mL during a 24-hour period after SLNDs appears to be safe and may significantly reduce duration of drain use and hospital length of stay.
