To use closed suction drain or not after total hip arthroplasty; A randomized controlled trial?

Aim
The aim of the study is to provide clinical evidence through an analysis of the pros and cons of using a closed-suction drain (CSD) system after primary total hip arthroplasty.
Patients and methods
We conducted a prospective, randomized, controlled trial in Assiut University Hospitals between February 2016 and July 2017. In all, 100 patients who underwent primary total hip arthroplasty (cemented and cementless) were enrolled and randomly allocated into two groups of 50 patients each: group A (patients had CSD) and group B (patients had no CSD). Patients with revision surgery, uncontrolled bleeding tendency, liver or renal impairment, and low preoperative hemoglobin (Hb) level less than 11 g/dl were excluded from the study. The primary outcomes were Hb reduction and the number of patients transfused and the volume of blood transfusion per patient. The secondary outcomes were evaluation of the wound [including early surgical site infection (SSI), wound discharge, need for dressing reinforcement, ecchymosis], time for operative procedure, and length of hospital stay.
Results
Hb reduction was more in the group of CSDs (group A: 3.01 g, group B: 2.57 g, < 0.04*). The number of patients transfused was also more in the CSD group (group A: 37/50, group B: 26/50, < 0.03*). The mean volume of blood transfused per patient was significantly higher in the CSD group (group A: 1.13 unit of blood, group B: 0.52 unit, < 0.02*). Patients without CSDs show more wound discharge (group B: 36/50, group A: 33/50, = 0.038*), more dressing reinforcements (group B: 2.02 dressing per patient, group A: 1.7, < 0.03*), and more ecchymosis (group B: 30/50, group A: 23/50, < 0.04*). No significant difference concerning time for surgical procedure, early SSI, or length of hospital stay.
Conclusion
CSD had a negative effect on Hb reduction and rate and volume of blood transfusion (more Hb reduction and subsequently more transfusion requirements), while it had a positive effect on wound condition (less wound discharge, less dressing reinforcements, less ecchymosis), and no effect regarding early SSI, time for surgical procedure, and length of hospital stay.