The impact of postoperative drain placement on perioperative management in anterior cervical discectomy and fusion (ACDF).

STUDY

DESIGN

This study is a single-center, retrospective cohort analysis of patients who underwent anterior cervical discectomy and fusion (ACDF) at Lanzhou University Second Hospital between January 2021 and April 2025. Patients were stratified according to the number of fusion levels (single-level, two-level, and ≥ three-level) and grouped based on the presence or absence of a drain. Perioperative variables, laboratory markers, radiological measurements, clinical scores, length of hospitalization, and associated costs were compared (P < 0.05).

OBJECTIVE

The aim of this study was to assess the impact of postoperative drain placement on perioperative outcomes in ACDF with varying numbers of fused levels, with the goal of providing evidence for the development of individualized drainage strategies.

BACKGROUND

ACDF is widely used for the treatment of cervical spondylosis, but postoperative hematoma remains a major concern. Routine drain placement has become a standard practice; however, advancements in hemostatic techniques and the implementation of enhanced recovery after surgery (ERAS) protocols have questioned its necessity, particularly in single-level procedures. While omitting drains appears to be safe in single-level ACDF, evidence for multi-level procedures remains limited.

METHODS

A total of 297 patients were reviewed (192 in the drain group and 105 in the non-drain group). Variables examined included surgical time, blood loss, inflammatory markers (white blood cell count, C-reactive protein), pain (NRS), function (ADL), prevertebral soft tissue thickness (PSTT), length of hospitalization, and costs.

RESULTS

In single-level and two-level ACDF, the non-drain group demonstrated significantly shorter hospital stays and lower costs (P < 0.01), with no significant differences in blood loss, inflammatory markers, PSTT, or functional recovery. The 48-hour NRS score in the drain group was slightly higher but remained below the minimal clinically important difference (MCID). In multi-level ACDF, the drain group had longer surgical times, higher inflammation, and higher costs, though comparisons were limited by the small sample size of the non-drain group.

CONCLUSION

In single-level and two-level anterior cervical discectomy and fusion (ACDF), omitting postoperative drains may be associated with shorter hospital stays and lower costs; however, further studies are needed to confirm safety. In multi-level ACDF, drain placement should be individualized based on the patient's condition and surgeon's evaluation, considering factors like blood loss and comorbidities. Future studies are needed to clarify the clinical outcomes of drainage strategies and support personalized decision-making protocols.