How long can suction drains be safely retained after surgery for musculoskeletal malignant tumors?

Abstract

In orthopaedic surgery, prolonged suction drainage has been associated with an increased risk of infection, and drain removal within 24 h is generally recommended. However, whether this recommendation applies to musculoskeletal tumor surgery, which is often more invasive and associated with substantial postoperative drainage, remains unclear. This study investigated the relationship between postoperative drainage duration and surgical site infection (SSI) following surgery for musculoskeletal malignant tumors. We prospectively studied all patients who underwent surgery for musculoskeletal malignant, metastatic, or intermediate tumors at our institution between December 2022 and November 2023. The maximum drainage duration was predetermined as 14 days. SSI was diagnosed according to the Centers for Disease Control and Prevention criteria. Forty-four patients (mean age, 66 years; range, 19–87 years) were included: 20 with malignant bone tumors (primary 3; metastatic 17), 17 with malignant soft tissue tumors (primary, 16; metastatic, 1), and 7 with intermediate tumors. Mean tumor size was 8.7 cm (range, 2–25 cm). Mean drainage duration was 8 days (range, 2–14 days), mean total drainage volume was 717 mL (range, 10–2622 mL), and mean drainage volume at removal was 34 mL/day (range, 0–173 mL/day). SSI occurred in two patients (4.5%), both with soft tissue sarcoma of the back who underwent drainage for 14 days. Exploratory logistic regression analysis demonstrated an association between drainage duration and SSI (odds ratio, 2.6; 95% confidence interval, 1.1–42.9; p = 0.017), whereas drainage volume at removal and total drainage volume were not associated with SSI. Exploratory receiver operating characteristic analysis suggested a drainage duration of 13 days as a potential cutoff for SSI prediction, and drainage duration ≥ 13 days was significantly associated with SSI ( p = 0.038). No SSI occurred in patients whose drains were removed within 12 postoperative days. Although prolonged drainage duration was associated with SSI, the small number of infection events precludes definitive conclusions regarding a safe drainage threshold. These findings suggest that drainage beyond 24 h may be feasible in musculoskeletal tumor surgery, but larger studies are required before specific recommendations can be made.