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Nguyen M, Foreman A, Lockwood C. The effectiveness of fibrin sealants in head and neck surgery: a systematic review protocol. JBI Evid Synth 2023:02174543-990000000-00241. [PMID: 38015095 DOI: 10.11124/jbies-23-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE This review will investigate the effectiveness of fibrin sealants in adult patients who underwent head and neck surgery. INTRODUCTION Controlling bleeding is important in head and neck surgery. Complications involving nearby vital structures increase the risk of morbidity and mortality. Surgical tissue adhesives are used in addition to other traditional hemostatic methods to reduce surgical site bleeding. Fibrin sealants have shown some success compared with other tissue adhesives, but individual studies have been inconclusive. INCLUSION CRITERIA We will include studies comparing fibrin sealants with placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement. Primary outcomes include wound complications and time to surgical drain removal. Secondary outcomes include length of hospital stay, drain volume output, surgical management of postoperative hematoma, rate of blood transfusions, and adverse reactions. METHODS We will search electronic databases (PubMed, Embase, Cochrane Database of Controlled Trials) for studies published from 1975 onwards. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Study screening and selection will be performed, and critical appraisal conducted using the standardized JBI appraisal tools. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences for continuous data. Risk ratios will be used for dichotomous data. Certainty will be reported using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION PROSPERO CRD42023412820.
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Affiliation(s)
- Marie Nguyen
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, South Australia
| | - Andrew Foreman
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, South Australia
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Liu AQ, Butskiy O, Cheung VWF, Anderson DW. The timing of drain removal in parotidectomies: outcomes of removal at 4 h post-operatively and a Canadian survey of practice patterns. J Otolaryngol Head Neck Surg 2023; 52:60. [PMID: 37705038 PMCID: PMC10500887 DOI: 10.1186/s40463-023-00665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study aimed to assess: (1) outcomes and complications after early drain removal (< 4 h, post-operative day [POD] 0) versus late drain removal (POD ≥ 1); (2) current Canadian provider practices. METHODS A single surgeons ten-year parotidectomy practice was reviewed, spanning his practice change from routine POD ≥ 1 drain removal to POD 0 removal, with extraction of patient demographic, disease, and complication variables. An anonymous, cross-sectional survey on parotid drain practices was distributed to Canadian Society of Otolaryngology-Head and Neck Surgery members. Descriptive statistics, Wilcoxon Rank Sum, and unpaired student's t-tests were calculated. RESULTS In total, 526 patients were included and 44.7% (235/526) had drains removed POD 0. There was no significant difference in hematoma or seroma rates between the POD 0 and POD ≥ 1 drain removal cohorts. The national survey on parotid drain management had 176 responses. The majority (67.9%) reported routinely using drains after parotidectomy and 62.8% reported using a drain output based criteria for removal. The most common cut-off output was 30 ml in 24 h (range 5-70 ml). CONCLUSION There was no difference in hematoma or seroma rates for patients with parotid drains removed on POD 0 versus POD ≥ 1. Our national survey found significant variation in Canadian parotidectomy drain removal practices, which may be an area that can be further assessed to minimize hospital resources and improve patient care.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada.
| | - Oleksandr Butskiy
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
| | | | - Donald W Anderson
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
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Roh JL. Sialocele formation after partial parotidectomy: Dependent on remnant parotid exposure. Head Neck 2023; 45:1299-1304. [PMID: 36939294 DOI: 10.1002/hed.27348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND This study compared the complete closure versus the exposure of remnant parotid parenchyma in sialocele formation. METHODS This study included 151 patients with benign parotid lesions who underwent partial parotidectomy plus the complete closure or exposure of remnant parotid parenchyma. Two surgical methods of closed or exposed parenchyma were alternatively allocated to consecutive patients without randomization and blinding processes. RESULTS Complete closure and exposure of the remnant parotid parenchyma were performed in 81 and 70 patients. Early postoperative complications occurred with temporary events: transient facial weakness, 24 (16%); hematoma, 9 (6%); wound infection, 1 (0.7%) without statistical difference between the two groups (p > 0.1). Postoperative sialocele was more frequently found in the exposure group (n = 15) than the closure group (n = 4; p = 0.003). CONCLUSIONS The complete closure of remnant parotid parenchyma is preferred over the exposure of injured parenchymal parenchyma to prevent postparotidectomy sialocele.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.,Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea
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The formulation of an enhanced recovery programme for patients undergoing laryngectomy. The Journal of Laryngology & Otology 2022; 136:848-860. [DOI: 10.1017/s0022215122000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveEnhanced recovery programmes have been widely adopted in other surgical disciplines but are not commonplace in head and neck surgery. The authors of this study created a pathway for post-operative laryngectomy patients.MethodA multidisciplinary working group reviewed the literature and agreed standards of care. A retrospective audit was conducted to measure current practice against our new pathway; after programme implementation our performance was reaudited in two prospective cycles, with an education programme and review after the first prospective cycle.ResultsStatistically significant improvement in performance was realised in catheter and surgical drain removal, opiate analgesia use, mobilisation, and timeliness of swallow assessment. The rate of hospital acquired pneumonia reduced from 23.1 to 9.5 per cent and length of stay reduced by a median of 5.2 days to 14.8 days (non-significant).ConclusionThe programme improved consistency of patient care across most areas that were measured. Improving patient stoma training needs to be prioritised.
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Bohorquez D, Pena S, Weed D, Ma R, Arnold DJ. Effect of Drain Output on the Timing of Closed Suction Drain (CSD) Removal After Head and Neck Surgery. Cureus 2022; 14:e23391. [PMID: 35481318 PMCID: PMC9033514 DOI: 10.7759/cureus.23391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
Background: A closed suction drain (CSD) is often utilized in head and neck surgical procedures to obliterate dead space. CSDs reduce seroma and hematoma formation, thereby improving skin apposition and wound healing. The use of drains for prolonged periods of time, however, may increase the risk of wound infection. Interestingly, the evidence regarding the need for, and management of, post-operative CSDs after head and neck surgery is scarce. The current criterion of drain removal when output is less than 30 cubic centimeters (cm3) within a 24-hour period and/or on the third post-operative day (POD) is widely utilized. The aforementioned criterion is based on anecdotal evidence from small studies with specific surgical procedures. In this study, we aim to evaluate the criteria for drain removal and to lay the groundwork for an updated paradigm for drain management in head and neck oncologic surgery. Study Design: Retrospective cohort study Setting: Academic tertiary care hospital Methods: A retrospective study was performed. Patients were included if they underwent head and neck surgery at the University of Miami Hospital between January 1, 2019 and July 1, 2020 and had at least one CSD. Volume of drain output on each POD was recorded until the day of drain removal. The development of post-operative wound complications (i.e., seroma, hematoma, infection/abscess, and dehiscence) was also recorded. Results: From our initial cohort of 302 patients, 145 patients met inclusion criteria. A total of 10 patients developed a post-operative wound complication. Patients had a mean age of 58.3 ± 15.0 years. The median inter-quartile range (IQR) drain output (cm3) on the day of CSD removal from patients who developed a wound complication was similar (15; IQR, 5-37.5) when compared to those who did not develop a wound complication (25; IQR, 10-30). This difference was not statistically significant (p = 0.60). Additionally, the cohort who developed a post-operative wound complication had their drain removed on an earlier POD (1; IQR, 1-1 (Mean 1.2)) when compared to the cohort who did not develop any complications (1; IQR, 1-1 (Mean 1.5)). This difference was also not statistically significant (p = 0.48) . Conclusion: There is no association between drain output (cm3) or day of CSD removal with the development of wound complications. These results warrant further studies to prospectively evaluate earlier CSD removal in head and neck surgery.
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Tranexamic acid in head and neck procedures: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2021; 279:2231-2238. [PMID: 34661715 DOI: 10.1007/s00405-021-07132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We conducted a meta-analysis of all randomized controlled trials (RCTs) that examined the benefits of tranexamic acid (TXA) among cancer patients undergoing head and neck (H&N) procedures. METHODS We screened five databases from inception until 20 June 2021 and evaluated the risk of bias of the eligible studies. We pooled continuous outcomes using the weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Five studies, comprising seven RCTs, met the inclusion criteria. This meta-analysis included a total of 540 patients; 265 and 275 patients were assigned to the TXA and control group, respectively. Overall, the included RCTs revealed a low risk of bias. The volume of postoperative bleeding was significantly lower in favor of the TXA group compared with the control group (n = 7 RCTs, WMD = - 51.33 ml, 95% CI [- 101.47 to - 1.2], p = 0.04). However, no significant difference was found between both groups regarding the volume of intraoperative bleeding (n = 6 RCTs, WMD = - 3.48 ml, 95% CI [- 17.11 to 10.15], p = 0.62), postoperative hemoglobin (n = 3 RCTs, WMD = 0.42 mg/dl, 95% CI [- 0.27 to 1.11], p = 0.23), duration of drainage tube removal (n = 4 RCTs, MD = - 0.41 days, 95% CI [- 1.14 to 0.32], p = 0.27), and operation time (n = 6 RCTs, WMD = 1.59 min, 95% CI [- 10.09 to 13.27], p = 0.79). TXA was safe and did not culminate in thromboembolic events or major coagulation derangements. CONCLUSION TXA administration is safe and significantly reduces the volume of postoperative bleeding. However, no difference is identified between TXA and control groups regarding the volume of intraoperative bleeding, postoperative hemoglobin level, duration of drainage tube removal, and operation time.
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Sethia R, Freeman T, Mead K, Selhorst A, Vala K, Skoracki L, Adelman M, VanKoevering K, Kang SY, Ozer E, Agrawal A, Old MO, Carrau RL, Rocco JW, Seim NB. Patient-Directed Home Drain Removal in Head and Neck Surgery. Laryngoscope 2021; 131:2471-2477. [PMID: 33847392 DOI: 10.1002/lary.29556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to evaluate the efficacy and safety of at home drain removal in head and neck surgery patients. METHODS The study population included patients who underwent head and neck surgery at an academic tertiary care center between February 2020 and November 2020 and were discharged with one to four drains with instructions for home removal. Prior to discharge, patients received thorough drain removal education. Patients were prospectively followed to evaluate for associated outcomes. RESULTS One hundred patients were evaluated in the study. There was record for ninety-seven patients receiving education at discharge. The most common methods of education were face-to-face education and written instructions with educational video link provided. Of 123 drains upon discharge, 110 drains (89.4%) were removed at home while 13 (10.6%) were removed in office. Most drains were located in the neck (86.4%). There was one seroma, two hematomas, two drain site infections, and five ED visits; however, none of these complications were directly associated with the action of drain removal at home. Calculated cost savings for travel and lost wages was $259.82 per round trip saved. CONCLUSIONS The results demonstrate that home drain removal can provide a safe and efficacious option for patients following head and neck surgery. This approach was safe and associated with patient cost savings and better utilization of provider's time. Furthermore, patients and healthcare providers avoided additional in-person encounters and exposures during the COVID-19 pandemic. Our findings warrant further investigation into cost savings and formal patient satisfaction associated with home drain removal. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Taylor Freeman
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Katherine Mead
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amanda Selhorst
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kelly Vala
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Laura Skoracki
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Megan Adelman
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
- Division of Head and Neck Oncology and Microvascular Reconstructive Surgery, The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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Go BC, Brewster R, Patel R, Rajasekaran K. Using Telemedicine and Infographics for Physician-Guided Home Drain Removal. OTO Open 2020; 4:2473974X20933566. [PMID: 32548544 PMCID: PMC7273559 DOI: 10.1177/2473974x20933566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
Objective Measures to decrease hospital length of stay and outpatient visits are
crucial during the coronavirus disease 2019 (COVID-19) pandemic.
Physician-guided home drain removal presents a potential opportunity for
mitigating viral spread and transmission. Methods A prospective case series on patients undergoing major head and neck surgery
with Jackson-Pratt drain placement was conducted. Patients were shown an
infographic detailing drain care and removal at preoperative assessment and
prior to discharge. At a 1-week follow-up telemedicine visit, patients were
instructed to remove the drain under physician guidance. Patients were
assessed 7 days after to determine complication rate and satisfaction. Results Twenty-five patients were enrolled with 100% patients undergoing successful
drain removal at home with caregiver support. There were no complications
reported at the 7-day postdrain removal time point, and overall patient
satisfaction was high. Discussion Infographics and telemedicine are 2 synergistic strategies to guide safe and
effective home drain removal. Implications for Practice This study demonstrates how telemedicine and an infographic can be
effectively used in physician-guided home drain removal. During a time like
the COVID-19 pandemic, innovative measures are necessary to curb
transmission and infection rates. We propose a unique and replicable yet
safe solution to limit unnecessary exposure and encourage other surgical
providers to adopt a similar strategy.
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Affiliation(s)
- Beatrice C Go
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Brewster
- Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Risha Patel
- Drexel University, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Thiagarajan S, Shah S. Utility of topical tranexamic acid in head-and-neck cancer surgery: A myth or reality? CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_266_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Does microbial colonisation of a neck drain predispose to surgical site infection: clean vs clean-contaminated procedures. Eur Arch Otorhinolaryngol 2018. [DOI: 10.1007/s00405-018-4921-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flam JO, Smith RV. What is the optimal time for removing drains in uncomplicated head and neck surgery? Laryngoscope 2017; 128:545-546. [PMID: 28895156 DOI: 10.1002/lary.26863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Juliette O Flam
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Saito I, Hasegawa T, Iwata E, Yonezawa N, Arimoto S, Takeda D, Sakakibara A, Akashi M, Minamikawa T, Komori T. Postoperative drainage in head and neck surgery for oral cancer. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kasbekar AV, Davies F, Upile N, Ho MW, Roland NJ. The management of vacuum neck drains in head and neck surgery and the comparison of two different practice protocols for drain removal. Ann R Coll Surg Engl 2016; 98:53-5. [PMID: 26688401 DOI: 10.1308/rcsann.2015.0055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The management of vacuum neck drains in head and neck surgery is varied. We aimed to improve early drain removal and therefore patient discharge in a safe and effective manner. Methods The postoperative management of head and neck surgical patients with vacuum neck drains was reviewed retrospectively. A new policy was then implemented to measure drainage three times daily (midnight, 6am, midday). The decision for drain removal was based on the most recent drainage period (at <3ml per hour). A further patient cohort was subsequently assessed prospectively. The length of hospital stay was compared between the cohorts. Results The retrospective audit included 51 patients while the prospective audit included 47. The latter saw 16 patients (33%) discharged at least one day earlier than they would have been under the previous policy. No adverse effects were noted from earlier drain removal. Conclusions Measuring drainage volumes three times daily allows for more accurate assessment of wound drainage, and this can lead to earlier removal of neck drains and safe discharge.
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Affiliation(s)
- A V Kasbekar
- Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospital NHS Foundation Trust , UK
| | - F Davies
- Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospital NHS Foundation Trust , UK
| | - N Upile
- Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospital NHS Foundation Trust , UK
| | - M W Ho
- Leeds Teaching Hospitals NHS Trust and Bradford Institute of Health Research , UK
| | - N J Roland
- Department of Otolaryngology, Head & Neck Surgery, Aintree University Hospital NHS Foundation Trust , UK
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Predictive factors for post-operative drainage after partial superficial parotidectomy: a case-control study. The Journal of Laryngology & Otology 2015; 129:1020-4. [DOI: 10.1017/s002221511500211x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:This study aimed to identify the pattern of post-operative drainage following partial superficial parotidectomy with and without the use of a bipolar vessel-sealing device.Methods:Of the 49 patients undergoing parotidectomies, a bipolar vessel-sealing device was used for 20. Predictive factors included in the analysis were age, sex, body weight, operating time, tumour pathology, and diabetes mellitus, hypertension and smoking status.Results:In multivariate analyses, body weight (p = 0.026) and non-use of a bipolar vessel-sealing device (p = 0.009) were significantly associated with increased post-operative drainage after 24 hours. There was also a trend towards increased drainage in diabetic patients. Operating times were significantly shorter in the bipolar vessel-sealing device group.Conclusion:Although 24-hour drainage appears adequate for most patients, in obese and diabetic individuals there is a risk of requiring increased drainage. Therefore, the drain should be left in place for a longer period. The bipolar vessel-sealing device is safe and time-efficient, and decreases the post-operative drainage period.
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Paradells VR, Pérez JBC, Vicente FJD, Florez LB, de la Viuda MC, Villagrasa FJ. Esophageal, pharyngeal and hemorrhagic complications occurring in anterior cervical surgery: Three illustrative cases. Surg Neurol Int 2014; 5:S126-30. [PMID: 24843808 PMCID: PMC4023006 DOI: 10.4103/2152-7806.130673] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/20/2014] [Indexed: 11/05/2022] Open
Abstract
Background: The number of esophageal and pharyngeal perforations occurring in anterior cervical surgeries ranges from 0.25% to 1% and 0.2% to 1.2%, respectively. Symptoms usually appear postoperatively and are attributed to: Local infection, fistula, sepsis, or mediastinitis. Acute postoperative hematoma, although very rare (<1%), is the first complication to rule out due to its life-threatening complications (e.g. acute respiratory failure). Case Description: Over a 36-year period, the author(s) described three severe esophageal/pharyngeal complications attributed to anterior cervical surgery. As these complications were appropriately recognized/treated, patients had favorable outcomes. Conclusions: Anterior cervical spine surgery is a safe approach and is associated with few major esophageal/pharyngeal complications, which most commonly include transient dysphagia and dysphonia. If symptoms persist, patients should be assessed for esophageal/pharyngeal defects utilizing appropriate imaging studies. Notably, even if the major complications listed above are adequately treated, optimal results are in no way guaranteed.
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Affiliation(s)
- Víctor Rodrigo Paradells
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
| | - Juan Bosco Calatayud Pérez
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
| | - Francisco Javier Díar Vicente
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
| | - Luciano Bances Florez
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
| | - Marta Claramonte de la Viuda
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
| | - Francisco Javier Villagrasa
- Neurosurgery Division Hospital Clínico Universitario "Lozano Blesa" de Zaragoza, Avenida San Juan Bosco 1550009 Zaragoza, Zaragoza, ESPAÑA, Spain
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