Influence of Posterior Spinal Surgery Drainage on Hematoma and Infections at Surgical Sites: A Systematic Review and Meta-Analysis.

ABSTRACT

Objective: The primary objective of this systematic review and meta-analysis was to assess the effectiveness of postoperative drainage in reducing the incidence of Surgical Site Hemorrhage (SSH) and Surgical Site Infections (SSI) in patients undergoing posterior spinal surgery. Methods: We conducted a comprehensive search of four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, to identify relevant studies. Only Randomized Controlled Trials (RCT) focusing on patients diagnosed preoperatively with non-infectious spinal diseases and undergoing posterior spinal surgery were included. The meta-analysis examined the efficacy of postoperative drainage in reducing SSH and SSI incidence. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias tool. Statistical analyses were conducted to evaluate heterogeneity and publication bias. Results: A total of seven studies met the inclusion criteria for SSH analysis, while six studies were included in the SSI analysis. The findings revealed a significant reduction in the incidence of SSH in patients with postoperative drainage, with a Relative Risk (RR) of 0.35 (95% CI 0.20 to 0.62, P < .01). However, no statistically significant impact was observed on the incidence of SSI (RR 0.97, 95% CI 0.36 to 2.59, P = .81). Funnel plot symmetry and Egger's linear regression test confirmed the absence of significant publication bias. Conclusions: The use of postoperative drainage in posterior spinal surgery is recommended to significantly reduce the risk of SSH. However, its effectiveness in preventing SSI remains inconclusive and requires further investigation. These can inform clinical decision-making and potentially improve patient outcomes.