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Despite numerous studies over the past few decades, the optimum strategy for deciding when to remove drains following axillary lymphadenectomy remains unknown. This meta-analysis aims to compare time-limited and volume-controlled strategies for drain removal.A total of 584 titles were identified following a systematic literature search of EMBASE, MEDLINE, Cinahl and the Cochrane library; 6 titles met our eligibility criteria. Data were extracted and independently verified by two authors. Time-limited drain removal was defined as drain removal at <5 days; volume-controlled strategies ranged from <20 ml/24 h to <50 ml/24 h.In all the studies, the time-limited approach resulted in earlier drain removal. Development of a seroma is 2.54 times more likely with early drain removal (Mantel-Haenszel Fixed Odds Ratio (OR) 2.54, p < 0.00001). However, there is no difference in infection rates between early and late drain removal (OR = 1.07, p = 0.76).This meta-analysis demonstrates that a strategy of early drain removal following axillary lymphadenectomy is safe, with no difference in infection rates; however, the incidence of seroma is significantly higher, which may necessitate more demanding outpatient care. There is a need for further well-designed clinical trials to address the clinical equipoise in this common area of surgical practice.

Original publication

DOI

10.1016/j.bjps.2016.09.027

Type

Journal article

Journal

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

Publication Date

12/2016

Volume

69

Pages

1614 - 1620

Addresses

Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK. Electronic address: davidthomson134@gmail.com.

Keywords

Axilla, Humans, Surgical Wound Infection, Breast Neoplasms, Lymphatic Metastasis, Seroma, Drainage, Device Removal, Lymph Node Excision, Female, Time-to-Treatment