Drainage systems in thyroid surgery: A randomised trial of passive and suction drainage

Objective: To investigate the effectiveness of high-vacuum and passive drai nage systems after elective thyroid resection. Design: Prospective randomised clinical study and multicentre postal survey . Setting: Military hospital, Germany. Patients: 80 patients, treated with passive closed drains (n = 40) or high- vacuum systems (n = 40). Interventions: 1. Measuring the amount of blood collected during drainage a nd the extent of residual haematoma on ultrasonography. 2. Survey in Austri a, Germany and Switzerland of annual number of bilateral thyroid resections , type of drainage used, and volume of postoperative drainage Results: 799 of the 1698 hospitals surveyed replied (47.2%). 785 (98.2%) of the 799 surgeons said that they used drainage systems of whom 766 (97.6%) used high-vacuum systems. In the 40 patients in whom passive closed drainag e was used, the median volume drained was 34 ml (range 0-175) compared with 115 ml (40-346) in the high vacuum group (p < 0.01). In the passive draina ge group the extent of residual haematoma measured by us was 4.4 ml (range 0-21.7) compared with 5.3 ml (0.6-24.9) in the high vacuum group. Conclusions: The high-vacuum drainage that is most commonly used in Austria , Germany, and Switzerland results in increased blood loss with no reductio n in the extent of residual wound haematoma and offers no additional advant age over passive drainage systems in thyroid surgery.