COMPARISON OF FOUR-DAY AND TEN-DAY POST-MASTECTOMY PASSIVE DRAINAGE IN ACCRA, GHANA

ABSTRACTObjectives: To determine the optimum period for passive post-mastectomy drainagein Accra, Ghana, comparing early (day 4) to late (day 10) drain removal.Design: Randomised prospective clinical study.Setting: Surgical Department, Korle Bu Teaching Hospital, Accra, GhanaSubjects: Patients with breast cancer scheduled for total mastectomy and level 11axillary clearance.Interventions: Patients were randomised to one of the two groups: early (day 4) andlate (day 10) passive drainage.Main outcome measures: Duration of hospital stay, seroma formation and postoperativewound infection.Results: Forty five patients had 4-day drainage and 42 had 10-day drainage. Lateremoval of drains (Day 10) was associated with a significantly higher drainage(1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Lateremoval, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspiratevolumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Earlyremoval had a shorter hospital stay of 6.2 (+1.52) days compared to 11.07 (+ 0.76)days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There wasa low incidence of seromas when drainage was <30 ml/day at the time of drainremoval.Conclusions: Post-mastectomy passive drains may be removed when drainage is <30ml in 24 hours. When there is a persistent large volume of axillary drainage, patientsshould be counselled about the relative risks of early and late drain removal. Forpatients who do not find seroma aspiration unacceptable, early (day 4) removalappears preferable to late (day 10) removal of drains