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    Journal Club Headneck

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    Marco Paulo Neri

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    © All Rights Reserved
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    Journal Club Headneck

    Uploaded by

    Marco Paulo Neri
    5 views20 pages

    Original Title

    JOURNAL CLUB HEADNECK

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    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    5 views20 pages

    Journal Club Headneck

    Uploaded by

    Marco Paulo Neri

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Marco Neri, MD

    Journal club, April


    24, 2019
    Background
    Drainage after routine thyroid and
    parathyroid surgery remains
    controversial
    Increasing evidence from a number of
    randomized clinical trials (RCTs)
    suggesting no benefit from the use of
    drains
    The routine use of drains in many
    surgical procedures is no longer
    recommended
    Background
    Haematoma rates are low, with a
    reported incidence of 0 – 2·6 per
    cent and an even lower incidence
    of 0 – 1·5 per cent for those
    requiring intervention
    Population
    Inclusion criteria
     All published and unpublished RCTs in any language
    comparing the use of any form of postoperative
    drainage (open, passive or suction) versus no
    drainage in patients of any age who underwent any
    thyroid or parathyroid surgery, irrespective of
    indication
    Exclusion criteria
     Lateral neck dissections
     Extensive neck surgery large goiters
     Substernal goiters, thoracotomy
     Minimaly invasive surgeries, previous thyroid
    surgeries
    Outcomes
    Rate of reoperation
    Wound infection rate
    Post operative pain
    Length of hospital stay
    Search strategy
    Search terms ‘thyroid’ or ‘thyroidectomy’ or
    ‘Graves’ or ‘goitre’ or ‘parathyroid’ or
    ‘parathyroidectomy’ and ‘drain’ or
    ‘drainage’ or ‘surgery’
    Databases searched:
    Coch-rane Library and Central Register of
    Controlled Trials (April 2013), MEDLINE
    (January 1966 to April 2013), Embase
    (January 1980 to April 2013) and Cumulative
    Index to Nursing and Allied Health (CINAHL)
    (January 1982 to April 2013)
    Stastical analysis
     The software package RevMan 5.2 (Cochrane
    Collaboration, Nordic Cochrane Centre,
    Copenhagen, Denmark) was used to analyse
    data. Risk ratios (RRs) and 95 percent
    confidence intervals (c.i.) were used for
    dichotomousvariables, and mean differences
    (MDs) with 95 % c.i. for continuous data
    Results
     Twenty-five trials reported on reoperation
    rate, including a total of 2939 patients. The
    rate of reoperation was low in both the drain
    and no-drain groups. The need for
    reoperation was no different between the
    two groups.
    Results
    Wound infection rates were reported in
    17 trials, including a total of 2035
    patients. There was a higher wound
    infection rate in the drain group.
    Conclusion
    This meta-analysis suggests
    that it is safe not to use drains
    following routine thyroid surgery
    and that this practice may have
    some benefits for the patient
    Critical appraisal
     Are the results of the study valid?
     Did the study ask a clearly focused question?
     YES
     Was this an RCT and was it appropriately so?
     YES
     Were the participants appropriately allocated to
    intervention and control groups?
     YES
    Were the participants, staff, and study
    personnel blind to participants’ study group?
    NO
    Were all of the participants who entered the
    trial accounted for at its conclusion?
    YES
    Were the participants in all groups followed
    up and data collected in the same way?
    YES
    Did the study have enough participants
    to minimize the play of chance?
    YES
     Were all important outcomes considered so the
    results can be applied?
     YES
    Thank you! :)

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