Comparing the Effectiveness of Active Drain to Passive Drain in Reducing Complications after Mastectomy: A Systematic Review

Abstract

Abstract Passive drain use after mastectomy may not cause seroma, and the use of active drains is associated with prolonged effluent drainage due to the persistent opening of axillary lymphatics from vacuum pressure. We compared passive and active drains in terms of seroma, flap necrosis, and drain use duration. We assessed studies comparing active and passive drainage using the PubMed, Cochrane Library, and Google Scholar databases. RevMan 5.4 was used for the data analysis. The odds ratio (OR) was used to derive dichotomous data (seroma and flap necrosis), and the mean difference (MD) was used to analyze continuous data (duration of drain use). We assessed the risk of bias using the RoB 2. The meta-analysis included 430 patients with a mean age of 46.0 to 55.76 years. The data for seroma were derived from three studies, and there was no difference between the two types of drains (OR: 0.68, 95% confidence interval [CI]: 0.38–1.21, I 2 = 0). The rate of flap necrosis (derived from two studies) did not differ between the two types of drains (OR: 0.82, 95% CI: 0.2–3.31, I 2 = 0). However, patients with passive drains had a shorter duration of use than those with active drains (MD: 0.54, 95% CI: 0.04 to 1.04, I 2 = 47). Active drains are not superior to passive drains in reducing seroma and flap necrosis rates. In addition, passive drainage may reduce the duration of drain use, with the potential to reduce the length of hospital stay, especially in developing countries, where patients are kept in the hospital for drain after mastectomy. The small number of participants necessitates future multicenter large randomized controlled trials to confirm our findings.