{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T06:15:46Z","timestamp":1790057746137,"version":"4.0.1"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>After lumbar spine surgery, postoperative drain removal often delays discharge. Whether inpatient drain removal reduces the risk of surgical site infection (SSI) or hematoma remains controversial. Therefore, in patients undergoing elective lumbar spine surgery, the authors sought to determine the impact of inpatient versus outpatient drain removal on the following variables: 1) length of hospital stay (LOS), and 2) postoperative complications.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A single-center retrospective cohort study in which the authors used prospectively collected data of patients undergoing primary, elective, 1- or 2-level lumbar spine decompression and\/or fusion was undertaken between 2016 and 2022. Patients with intraoperative or postoperative CSF leaks were excluded. The primary exposure variable was inpatient versus outpatient drain removal. The primary outcome was LOS, and secondary outcomes were postoperative complications, including 90-day postoperative SSI or hematoma. Multivariable logistic and linear regression were performed, controlling for age, body mass index, instrumentation, number of levels, antibiotics at discharge, and surgeons involved.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 483 patients included, 325 (67.3%) had inpatient drain removal and 158 (32.7%) had outpatient drain removal. Patients with outpatient drain removal were significantly younger (58.6 \u00b1 12.4 vs 61.2 \u00b1 13.2 years, p = 0.040); more likely to have 1-level surgery (75.9% vs 56.6%, p &lt; 0.001); and less likely to receive instrumentation (50.6% vs 69.5%, p &lt; 0.001). Postoperatively, patients with outpatient drain removal had a shorter LOS (0.7 \u00b1 0.6 vs 2.3 \u00b1 1.6 days, p &lt; 0.001); were more likely to be discharged home (98.1% vs 92.3%, p = 0.015); were more likely to be discharged on antibiotics (76.6% vs 3.1%, p &lt; 0.001); were less likely to be on opioids (32.3% vs 88.3%, p &lt; 0.001); and were more likely to have Jackson-Pratt compared to Hemovac drains (96.2% vs 34.5%, p &lt; 0.001). No difference was found in SSI (3.7% vs 3.8%, p &gt; 0.999) or hematoma (0.9% vs 0.6%, p &gt; 0.999), as well as reoperation or readmission due to SSI or hematoma. On multivariable regression, outpatient drain removal was significantly associated with shorter LOS (\u03b2 = \u22121.15, 95% CI \u22121.56 to \u22120.73, p &lt; 0.001). No association was found with SSI\/hematoma (p &gt; 0.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Outpatient drain removal after elective lumbar spine surgery was associated with a significantly decreased LOS without a significant increase in postoperative SSI or hematoma. Although the choice of drain removal and the LOS may be subject to surgeons\u2019 preference, these results may support the feasibility and safety of outpatient drain removal, and the potential cost savings resulting from shortened hospital stays. Drawbacks may exist regarding added burden to the patient and the surgeon\u2019s team to accommodate 1-week follow-up appointments for drain removal.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.spine231338","type":"journal-article","created":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T02:01:05Z","timestamp":1715997665000},"page":"216-223","source":"Crossref","is-referenced-by-count":3,"title":["Safety of early discharge after elective lumbar spine surgery with subfascial drains and association with significant reduction in length of stay"],"prefix":"10.3171","volume":"41","author":[{"given":"Hani","family":"Chanbour","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel A.","family":"Bendfeldt","sequence":"additional","affiliation":[{"name":"Vanderbilt University, School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi Suryateja","family":"Gangavarapu","sequence":"additional","affiliation":[{"name":"Vanderbilt University, School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda H.","family":"Wright","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silky","family":"Chotai","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond J.","family":"Gardocki","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob P.","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir M.","family":"Abtahi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Orthopedic Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron F.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Orthopedic Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Orthopedic Surgery, Vanderbilt University Medical Center, Nashville; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Berkman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Eur Spine J","first-page":"708","article-title":"Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire","volume":"25","author":"von Eckardstein KL","year":"2016","unstructured":"von Eckardstein KL, Dohmes JE, Rohde V. Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire. Eur Spine J. 2016;25(3):708\u2013715."},{"issue":"2","key":"b2","series-title":"AORN J","first-page":"266","article-title":"Surgical vacuum drains: types, uses, and complications","volume":"91","author":"Durai R","year":"2010","unstructured":"Durai R, Ng PCH. Surgical vacuum drains: types, uses, and complications. AORN J. 2010;91(2):266\u2013274."},{"issue":"1","key":"b3","series-title":"Ann Plast Surg","first-page":"4","article-title":"A brief history of two common surgical drains","volume":"77","author":"Meyerson JM","year":"2016","unstructured":"Meyerson JM. A brief history of two common surgical drains. Ann Plast Surg. 2016;77(1):4\u20135."},{"issue":"1","key":"b4","series-title":"Ann R Coll Surg Engl","first-page":"60","article-title":"A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods","volume":"101","author":"Heskin L","year":"2019","unstructured":"Heskin L, Cahill V, Filobbos G, Regan P, O\u2019Sullivan ST, Bryan K. A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods. Ann R Coll Surg Engl. 2019;101(1):60\u201368."},{"issue":"10","key":"b5","series-title":"Cochrane Database Syst Rev","first-page":"CD007258","article-title":"Wound drainage after plastic and reconstructive surgery of the breast","volume":"2015","author":"Khan SM","year":"2015","unstructured":"Khan SM, Smeulders MJC, Van der Horst CM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev. 2015;2015(10):CD007258."},{"issue":"4","key":"b6","series-title":"Plast Reconstr Surg Glob Open","first-page":"e4160","article-title":"Final 24-hour drain output and postoperative day are poor indicators for appropriate drain removal","volume":"10","author":"Chua C","year":"2022","unstructured":"Chua C, Bascone CM, Pereira C,  Final 24-hour drain output and postoperative day are poor indicators for appropriate drain removal. Plast Reconstr Surg Glob Open. 2022;10(4):e4160."},{"issue":"10","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"1066","article-title":"A randomized study of closed wound suction drainage for extensive lumbar spine surgery","volume":"29","author":"Brown MD","year":"2004","unstructured":"Brown MD, Brookfield KFW. A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976). 2004;29(10):1066\u20131068."},{"issue":"2","key":"b8","series-title":"Med Sci Monit","first-page":"CR64","article-title":"Is wound drainage necessary after lumbar spinal fusion surgery?","volume":"11","author":"Scuderi GJ","year":"2005","unstructured":"Scuderi GJ, Brusovanik GV, Fitzhenry LN, Vaccaro AR. Is wound drainage necessary after lumbar spinal fusion surgery? Med Sci Monit. 2005;11(2):CR64\u2013CR66."},{"issue":"20","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"2272","article-title":"Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients","volume":"32","author":"Ho C","year":"2007","unstructured":"Ho C, Sucato DJ, Richards BS. Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. 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Eur Spine J. 2022;31(3):614\u2013622."},{"key":"b12","series-title":"World Neurosurg","first-page":"109","article-title":"The use of closed suction drainage in lumbar spinal surgery: is it really necessary?","volume":"90","author":"Liu JM","year":"2016","unstructured":"Liu JM, Chen WZ, Fu BQ, Chen JW, Liu ZL, Huang SH. The use of closed suction drainage in lumbar spinal surgery: is it really necessary? World Neurosurg. 2016;90:109\u2013115."},{"issue":"3-4","key":"b13","series-title":"World Neurosurg","first-page":"564","article-title":"The role of drains in lumbar spine fusion","volume":"77","author":"Walid MS","year":"2012","unstructured":"Walid MS, Abbara M, Tolaymat A,  The role of drains in lumbar spine fusion. World Neurosurg. 2012;77(3-4):564\u2013568."},{"key":"b14","series-title":"Int J Spine Surg","first-page":"34","article-title":"Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions","volume":"8","author":"Poorman CE","year":"2014","unstructured":"Poorman CE, Passias PG, Bianco KM, Boniello A, Yang S, Gerling MC. Effectiveness of postoperative wound drains in one- and two-level cervical spine fusions. Int J Spine Surg. 2014;8:34."},{"issue":"6","key":"b15","series-title":"Spine J","first-page":"847","article-title":"Measuring clinically relevant improvement after lumbar spine surgery: is it time for something new?","volume":"20","author":"Asher AM","year":"2020","unstructured":"Asher AM, Oleisky ER, Pennings JS,  Measuring clinically relevant improvement after lumbar spine surgery: is it time for something new? 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Eur Spine J. 2005;14(4):409\u2013414."},{"issue":"3","key":"b18","series-title":"J Spinal Disord Tech","first-page":"171","article-title":"Are drains useful for lumbar disc surgery? A prospective, randomized clinical study","volume":"19","author":"Mirzai H","year":"2006","unstructured":"Mirzai H, Eminoglu M, Orguc S. Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech. 2006;19(3):171\u2013177."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/2\/article-p216.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/2\/article-p216.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/2\/article-p216.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:19:41Z","timestamp":1733491181000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/2\/article-p216.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":18,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2024.3.spine231338","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}