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At-Home Postoperative Drain Removal Is Safe and Effective for Many Head and Neck Surgery Patients

by Linda Kossoff •

How safe and effective is home drain removal in head and neck surgery patients?

BOTTOM LINE

Home drain removal is a safe and efficacious option for patients following head and neck surgery, providing cost savings to them and better utilization of providers’ time.

BACKGROUND: Used to minimize fluid accumulation within a surgical site, closed suction drains require active postoperative surveillance. Drains are commonly removed after a few days in the hospital or at a follow-up office visit, but both settings have significant drawbacks. Home drain removal is a potentially beneficial strategy that has not been thoroughly evaluated.

COMMENT: The authors evaluated a novel patient education protocol for home drain removal in patients after head and neck surgery. They found a low complication rate, and no complications were directly associated with the action of drain removal. This is a timely study, as home drain removal is a simple intervention with the potential for significant cost savings. The authors calculated direct cost savings for travel and lost wages of $260 per round trip, but cost savings associated with earlier discharge for patients with drains could be significant. —Andrés Bur, MD

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, The Ohio State University Medical Center, Columbus, Ohio.

SYNOPSIS: Researchers conducted a prospective study for patients who underwent surgery at a single institution between February 2020 and November 2020 and who were discharged with surgical drains intended for self-removal. There were 100 patients (66.0% men, 34.0% women, average age 59.5) in all. Patients received thorough drain removal education one to two days prior to discharge and were sent home with one to four drains intended for self-removal. Surgical procedures included neck dissection (68.0%), thyroidectomy (27.0%), and parotidectomy (23.9%). Outcomes of interest included complications associated with drain pull, documented seroma, hematoma, drain site infection, and ED visit. Although complications were reported, none were directly associated with the action of drain removal at home. Cost savings for forgoing a drain removal-related office visit were estimated at $259.82 per patient. Authors noted that prolonged hospital stays due solely to drain management were avoided. They also emphasized the importance of accessible, user-friendly, and simple instructions for patients, and reference guidelines regarding which patients are deemed too high risk for this option.

CITATION: Sethia R, Freeman T, Mead K, et al. Patient-directed home drain removal in head and neck surgery [published online ahead of print April 13, 2021]. Laryngoscope.