article · Journal of Orthopaedic Reports
This study evaluated the short-term outcomes of using improvised closed suction drains versus no drains in fifty patients undergoing primary total knee arthroplasty at an orthopaedic centre in Tanzania. In low-resource settings, surgeons sometimes fashion drains from modified intravenous sets and vacuum bottles to clear fluid. Comparing eleven patients who received improvised drains against thirty-nine who had no drainage, the study assessed postoperative haemoglobin levels, blood transfusion rates, length of hospital stay, and pain scores over five days. Patients managed with improvised drains exhibited significantly lower postoperative haemoglobin levels and required significantly more blood transfusions than those without drains. Furthermore, the improvised drainage did not reduce postoperative pain or the duration of hospital admission, indicating that routinely using these devices provides no clear clinical benefits.
Managing blood loss safely is critical during major joint surgery, particularly where donor blood supplies are limited. These findings show that improvising surgical suction drains increases blood loss and transfusion needs without improving recovery time or reducing pain, helping surgical teams make informed decisions that avoid unnecessary risks and preserve limited blood resources.
This clinical research provides immediate guidance for orthopaedic teams and hospital administrators in resource-limited settings regarding surgical protocols. Rather than creating a commercial product, the findings suggest that health providers can avoid the costs and risks of improvising drain devices. The evidence is derived from clinical practice and can directly inform hospital procedure guidelines.
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Background Total knee arthroplasty (TKA) is increasingly performed, yet the utility of closed suction drains remains debated, particularly in resource-limited settings. Drains aim to reduce hematoma but may increase blood loss. This study compares short-term outcomes following primary TKA using an improvised closed suction drain versus no drainage at a tertiary orthopaedic centre in Tanzania, where standard drains may be unavailable. Methods This prospective cohort study enrolled 50 consecutive patients undergoing primary TKA at Muhimbili Orthopaedic Institute. Patients receiving an improvised closed suction drain (n=11; modified IV set connected to vacuum bottle) were compared to those without a drain (n=39), based on surgeon preference. Data collected included demographics, pre- and postoperative hemoglobin (Hb) levels (measured days 3-5 post-op), allogeneic blood transfusion rates, length of hospital stay (LOS), and daily pain scores (Numeric Rating Scale 0-10) for 5 days. Independent t-tests and Fisher’s exact test were used for comparisons (P < 0.05). Results The cohort comprised 50 patients (88% female). The drain group had significantly lower mean postoperative Hb levels (8.46 ± 1.36 g/dL) compared to the no-drain group (9.79 ± 1.40 g/dL), with a mean difference of 1.33 g/dL (95% CI 0.37–2.29, P = 0.007). The transfusion rate was significantly higher in the drain group (45.5% [5/11]) versus the no-drain group (2.6% [1/39]) (P = 0.001). There were no statistically significant differences in mean LOS (Drain: 6.45 ± 3.35 days vs. No Drain: 5.25 ± 1.60 days; P = 0.100) or mean daily pain scores (P = 0.701). Conclusion In this Tanzanian cohort undergoing primary TKA, using an improvised closed suction drain was associated with significantly lower postoperative hemoglobin levels and a higher blood transfusion rate, without offering advantages in reducing hospital stay or postoperative pain. Routine use of such drains may be disadvantageous, particularly considering blood resource limitations.
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DOI: 10.1016/j.jorep.2025.100679
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