A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Study Design. This is a retrospective, cohort analysis of multi-institutional database. Objective. This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries. Summary of Background Data. After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement. Methods. The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation. Results. We identified 7943 patients during the study period. Propensity-score matching yielded 3206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of postoperative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs. 6.3%; P = 0.003) and had longer hospital stay (P < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (relative risk 1.23, 95% confidence interval [CI] 1.13-1.34; P < 0.001). There were no significant differences in other outcomes measured. Conclusion. Our analysis demonstrated that drain use is associated with significant longer hospital stay.