Authors (including presenting author) :
Choy WY(1), Sun HN (2)
Affiliation :
Surgical Nurse Clinic (Breast Care), Princess Margaret Hospital
Introduction :
Optimal timing for drain removal after breast surgery is crucial for patient recovery and satisfaction. Factors influencing drain duration include the volume of drainage, the type of surgery performed, and individual patient factors such as healing rates and complications.
Seroma formation is one of the most frequent complications after breast surgery; it may delay the initiation of adjuvant treatment, reduce quality of life, and deteriorate prognosis.
Therefore, optimal timing for drain management is key to preventing seroma formation.
Current Practice:
There is no single standardised guideline for removing drain after breast surgery in Kowloon
West Cluster (KWC) hospitals. In Yan Chai Hospital (YCH), drains are removed on day 10, while in Princess Margaret Hospital (PMH), drains are removed when the output is less than 30ml per day for three consecutive days, with a maximum duration of 21 days. Therefore, implementing a standardised guideline for drain management can enhance patient recovery and improve overall outcomes.
Objectives :
This study aims to review current literature and clinical practice to determine the most effective timing for drain removal in postoperative breast surgery patients and to establish a standardised guideline at KWC.
Methodology :
We conducted a comprehensive literature search from 2010-2024. A total of 9 studies were identified through this search. The studies indicated that seroma formation was significantly higher with early drain removal compared to late drain removal.
Early drain removal was defined as removal between postoperative day 1 and 7. Late drain removal varied among studies, with most defining it as removal on day 7 or later after breast surgery. Additionally, it depends on the drain output, which was reported as being less than 20 ml/day to 50 ml/day.
Meanwhile, a retrospective analysis was conducted on 83 patients who underwent breast surgery from January to June 2024 at PMH. Drain output was monitored, and removal criteria were based on current PMH protocol. The analysis showed that a total of 27 patients developed seroma. Among them, 12 patients had drains removed in less than 14 days, with total seroma tapping volumes ranging from 90 ml to 1541 ml. In contrast, 13 patients had drains removal after more than 14 days, with total seroma aspiration volumes ranging from 85 ml to 569 ml. Only 2 patients had drains removed on day 14, with total aspiration volumes of less than 25 ml.
Result & Outcome :
The literature review and analysis revealed that drains should not be removed either too early (before 14 days) or too late (after 14 days) to reduce the incidence of seroma formation. The results showed that drains could be safely removed on day 14 after breast surgery, and the drain output was consistently between 20 ml and 50 ml per day for two consecutive days.
Therefore, this new protocol will minimize the incidence of seroma formation and enhance patient comfort.
Recommendations:
Based on our findings, we recommend the following changes to our current practice starting in December 2024 as a pilot phase at PMH. First, implement a new protocol where drain placement is set for 14 days, and drains are typically removed when the output is consistently low, often around 20-50 ml per day for two consecutive days. Additionally, educate patients about the importance of timely drain removal and encourage them to communicate any concerns regarding their recovery. Finally, regularly review and evaluate the outcomes of the new protocol to ensure it meets the needs of our patients and aligns with best practices.
By adopting a maximum of 14 days for drain placement and focusing
on drainage output, we can enhance patient outcomes while minimizing complications. This evidence-based approach will ensure our department provides the highest quality of care to patients following breast surgery.
