Quantitative analysis of the drainage after neck dissection

Neck dissections: predicting postoperative drainage

OBJECTIVES

Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage.

MATERIALS AND METHODS

Radical, modified radical, and selective neck dissections performed in conjunction with resection of a carcinoma of the upper aerodigestive tract over a 3-year period were evaluated. Total intraoperative blood loss at surgery, and amount and duration of postoperative drainage for each neck dissection were recorded.

RESULTS

Seventy-nine neck dissections were performed on 52 patients, 27 (52%) of whom had bilateral neck dissections. Median drainage was 116.5 mL, 172 mL, and 319 mL for selective, modified radical, and radical neck dissections, respectively. Drainage differed significantly by type of neck dissection (P <.001). Drains remained in place a median of 4 days with no significant difference between different types of neck dissections. Drainage was clearly correlated with total intraoperative blood loss (Spearman correlation = 0.44, P <.001).

CONCLUSION

The postoperative drainage per day was higher in radical neck dissections than modified radical neck dissections and lowest in selective neck dissections. This difference was not reflected in the duration that the drains would remain in place. Total intraoperative blood loss is a strong predictor of the amount and duration of postoperative drainage.

Objective and early diagnosis of chylous fistula in the postoperative period

OBJECTIVE

The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period.

STUDY DESIGN AND SETTING

We prospectively evaluated 103 consecutive neck dissections during a 2-year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF.

RESULTS

A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001).

CONCLUSIONS

Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.