Suction drain has no role in decreasing postoperative wound infection and hematoma in lumbar decompression surgery.

Abstract

Objective: To determine the frequency of postoperative hematoma and wound infection in patients undergoing lumbar disc excision through fenestration without closed-suction drainage, thereby evaluating suction drains (or lack thereof) in reducing these complications. Study Design: Prospective Observational study. Setting: Orthopaedic & Spine Centre, Ghurki Trust Teaching Hospital, Lahore. Period: July 2025 and December 2025. Methods: Four hundred twenty-three patients aged 15–60 years undergoing lumbar disc excision through fenestration (without inserting a closed-suction drain) were enrolled. Exclusion criteria included prior spinal surgery, canal stenosis, cauda equina syndrome, uncontrolled diabetes or hypertension, and bleeding disorders. A single experienced surgeon performed all operations. Patients were observed for seven days postoperatively for signs of hematoma (clinical new or progressive neurological deficit, or MRI evidence) and wound infection. Quantitative variables (age) were expressed as mean ± SD; categorical variables (gender, hematoma yes/no) as frequency and percentage. Stratification for age groups and gender was performed. Results: The mean age was 44.53 ± 11.42 years; 27.66% (n=117) were aged 15–30, and 72.34% (n=306) were aged 31–60. Males comprised 74.94% (n=317) and females 25.06% (n=106). Postoperative hematoma occurred in 2.13% (n=9) of patients; 97.87% (n=414) had no hematoma. Among the hematoma cases, 33.33% (n=3) were 15–30 years old and 66.67% (n=6) were 31–60. By gender, 55.56% (n=5) of hematoma cases were male, and 44.44% (n=4) were female. No wound infections requiring intervention were recorded. Conclusion: In this large series of lumbar disc excisions via fenestration without closed-suction drainage, the incidence of postoperative hematoma was very low (2.13%), and no wound infections necessitating intervention were observed. These results promote an individualized rather than routine approach to drain use, supporting the mounting evidence that routine suction drain placement in lumbar decompression surgery offers no discernible reduction in hematoma or infection rates.