• Bryce A Basques, Daniel D Bohl, Nicholas S Golinvaux, Alem Yacob, Arya G Varthi, and Jonathan N Grauer.
• From the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
• Spine. 2014 Apr 20; 39 (9): 728-35.

Study DesignRetrospective cohort study.ObjectiveTo identify factors that are independently associated with increased surgical drain output in patients who have undergone ACDF.Summary Of Background DataSurgical drains are typically placed after ACDF to reduce the risk of complications associated with neck hematoma. The orthopedic literature has repeatedly challenged the use of surgical drains after many procedures, and there are currently no guidelines for determining which patients are most likely to benefit from drain placement after ACDF.MethodsConsecutive patients who underwent elective ACDF with surgical drain placement at a single academic institution between January 2011 and February 2013 were identified using billing records. Patient information was abstracted from the medical record. Patients were categorized on the basis of normal or increased total drain output, with increased drain output defined as total drain output 50th percentile (30 mL) or more. A multivariate logistic regression was used to determine which factors were independently associated with increased drain output.ResultsA total of 151 patients with ACDF met inclusion criteria. Total drain output was in the range from 0 mL to 265 mL. The average drain output for this cohort was 42.3 ± 45.5 mL (mean ± standard deviation). Among all patients in the study, 80 patients had increased drain output (drain output ≥50th percentile or 30 mL).Multivariate analysis identified 3 independent predictors of increased drain output: age 50 years or more (odds ratio [OR] = 3.9), number of levels (2 levels, OR = 2.7; 3-4 levels, OR = 17.0), and history of smoking (OR = 2.8). One patient developed a postoperative neck hematoma while a drain was in place.ConclusionPatients with the factors associated with increased drain output identified in the earlier text may benefit most from surgical drain placement after ACDF. Nonetheless, neck hematoma is still possible even with drain use.Level Of Evidence3.

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