Does Non-Placement of a Drain in Breast Surgery Increase the Rate of Complications and Revisions?

 

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Abstract

Purpose: Although surgical therapy for breast cancer has become less radical, intrasurgical placement of drains and the use of compression bandages is still standard practice. However, evidence for the clinical benefit of wound drains is controversial, and use of drains is associated with increased pain and longer hospital stays. This raises the question whether, given the latest surgical techniques, wound drainage is still medically necessary.
Material and Method: A retrospective analysis was done of patients with breast cancer treated surgically between January 2009 and April 2012 in the Breast Centre Hohenlohe (n = 573). Complication rates and revision following surgery with and without placement of wound drains were compared for patients who had breast-conserving surgery (n = 425) and patients who underwent mastectomy (n = 148).
Results: The baseline characteristics (age, number of resected lymph nodes, numbers of patients who had sentinel lymph node resection, tumour characteristics, receptor status and affected side) were comparable for the investigated patient groups. The overall rate of complications was 4 %. There was no significant difference with regard to complication rates after surgery with and without placement of wound drains between the group of patients with breast-conserving surgery and the group of patients with mastectomy (p = 0.68 and p = 0.54, respectively).
Conclusion: Our data indicate that non-placement of a wound drain does not influence complication or revision rates after breast-conserving surgery or mastectomy.

Zusammenfassung

Problem: Trotz der verringerten Radikalität der operativen Therapie des Mammakarzinoms werden häufig routinemäßig Redon-Drainagen angelegt. Der medizinische Nutzen von Drainage ist allerdings nicht unumstritten. Drainageneinlagen sind mit vermehrten Schmerzen und einer Verlängerung des stationären Aufenthalts verbunden. Somit stellt sich die Frage, ob eine Redon-Drainage in Anbetracht der aktuellen Operationstechniken heute noch medizinisch notwendig ist.
Material und Methode: In einer retrospektiven Analyse der im Zeitraum Januar 2009 – April 2012 operativ behandelten Mammakarzinompatientinnen des Brustzentrums Hohenlohe (n = 573) wurden Komplikations- und Revisionsraten zwischen Operationen mit und ohne Drainageneinlage sowohl für Patientinnen mit brusterhaltender Operation (n = 425) als auch für Patientinnen mit Mastektomie (n = 148) verglichen.
Ergebnisse: Die untersuchten Patientinnengruppen waren in Bezug auf Alter, entfernte Lymphknoten, Häufigkeit der Wächterlymphknotenentfernung, Tumoreigenschaften, Rezeptorstatus und Seitenverteilung vergleichbar. Die Komplikationsrate für das Gesamtkollektiv betrug 4 %. Weder für die Gruppe der Patientinnen mit brusterhaltender Operation noch für die Gruppe der Patientinnen mit Mastektomie gab es einen signifikanten Unterschied in der Häufigkeit des Auftretens von Komplikationen nach Operationen mit und ohne Drainageneinlage (p = 0,68; bzw. p = 0,54).
Schlussfolgerung: Unsere Daten deuten an, dass der Verzicht auf eine Drainageneinlage sowohl bei brusterhaltenden Operationen als auch bei Mastektomie nicht zu einer erhöhten Rate von konservativ behandelten Komplikationen und Revisionsoperationen führt.

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