Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial

L. Helenius, P. Gerdhem, M. Ahonen, J. Syvänen, J. Jalkanen, A. Charalampidis, Y. Nietosvaara, I. Helenius

Research output: Contribution to journalArticleScientificpeer-review


Aims The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AiS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Methods Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications. Results All 90 patients were included in the primary outcome analysis (no drain = 43; drain = 47). The mean total postoperative blood loss (intraoperative and drain output) was significantly higher in the group with a subfascial drain than in the no-drain group (1,008 ml (SD 520) vs 631 ml (SD 518); p < 0.001). The drop in haemoglobin level did not differ between the study groups over the postoperative timepoints (p = 0.290). The 48-hour opioid consumption was significantly higher in the no-drain group (2.0 mg/kg (SD 0.9) vs 1.4 (SD 0.6); p = 0.005). Two patients in the no-drain and one patient in the drain group developed a surgical site infection. Conclusion Leaving the subfascial drain out after pedicle screw instrumentation for AiS is not associated with higher postoperative haemoglobin levels. patients treated without a subfascial drain needed 30% more opioids during the first 48 hours than those who had a drain.

Original languageEnglish
JournalBone and Joint Journal
Volume104 B
Issue number9
Pages (from-to)1067-1072
Number of pages6
Publication statusPublished - Sep 2022
MoE publication typeA1 Journal article-refereed

Bibliographical note

Publisher Copyright:
© 2022 The British Editorial Society of Bone & Joint Surgery.

Fields of Science

  • 3123 Gynaecology and paediatrics
  • 3126 Surgery, anesthesiology, intensive care, radiology

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