Abstract
Postoperative management often demands the introduction of several strategies in an attempt to minimize complication rates. One of the routine strategies includes the use of spinal drains, which have been questioned for their efficacy in improving postoperative outcomes. However, its role in postoperative outcomes is still debated. In general, this elucidation of an extensive literature review supports the synthesis of current evidence regarding the role of spinal drains in infection rates, hematoma formation, and overall patient recovery. A comprehensive search of PubMed from 2000 to 2024 was performed, focusing on studies investigating the use of spinal drains in spinal surgeries and their associated postoperative outcomes. It followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were studies related to spinal surgeries, excluding case reports, reviews, and editorials, and limited to articles published in English. Quality assessment was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A total of 19 studies were included, with different designs and varied sample sizes. The sample size was from 25 to 2,446 patients. Findings on infection rates were mixed; while one group of studies showed no significant differences in patients with and without drains, another group showed a reduced rate of reoperation for surgical site infections in patients with drains. In general, hematoma formation rates were reported to be the same across groups, while a few studies indicated that drains were more effective in managing wound exudates compared to no drains. Recovery outcomes indicated that patients who had a wound drain were more likely to stay in the hospital longer, although an improvement was noticed with time-driven wound drain removal, which resulted in shorter hospital stays and earlier ambulation. The use of spinal drains in postoperative spinal surgery presents both benefits and drawbacks. Spinal drains can assist in the management of wound exudates, and earlier detection of infection complications increases hospital stays and complications. Indeed, whether to use spinal drains or not should be an individual decision, weighing the potential benefits and risks. Future studies need to be done in order to establish clear guidelines for the use of drainage systems in various spinal surgical cases.