The use of subfascial drains after multi-level anterior cervical discectomy and fusion: does the data support its use?

Subfascial drains are routinely used after multi-level anterior cervical discectomy and fusion (ACDF) procedures despite little evidence to support their use. Proponents of drain use argue that drain placement reduces the incidence of post-operative hematomas and surgical site infections (SSI). The aim of this study is to determine whether the use of subfascial drains after multi-level ACDFs are associated with a decreased incidence of hematomas and SSIs.This is a retrospective study of 321 consecutive adult patients (18 years and older) with degenerative cervical stenosis that undergoing an index multi-level ACDF procedure. Only patients undergoing multilevel ACDF were included in the study. Patients were separated into one of two groups depending whether a subfascial drain was placed during surgery. The decision to place a drain was based on surgeon preference. Baseline characteristics, operative details, as well as rates of hematoma formation and SSIs were gathered by direct medical record review.Of the 321 patients enrolled in the study, 58 (18%) patients had subfascial drains placed at the time of surgery. Baseline demographics and co-morbidities were similar between both cohorts; however, on average, patients in the "Drain Use" cohort were older when compared to those in the "No Drain" cohort (64 vs. 56 years old, P<0.0001). There was no observed difference between both groups in the incidence of post-operative hematoma formation (P=0.99) or SSI (P=0.99). Five percent of patients in the "Drain Use" cohort required a post-operative allogenic blood transfusion compared to less than 1% (0.4%) in the comparison cohort. The duration of hospital stay was almost 2-fold longer in the in the "Drain use" cohort compared to the comparison cohort ("Drain Use": 2.82 days vs. "No Drain": 1.58 days, P<0.0001).The use of subfascial drains after multi-level ACDF procedures were not associated with a decreased incidence of hematoma formation or SSIs. In fact, patients in which a subfascial drain was used were 14 times more likely to require a post-operative blood transfusion and with an almost 2-fold increase in the duration of in-hospital stay.