Authors (including presenting author) :
Wong L, Cheung HHB, Tsang YL, Lau YC, Chang YK, Lee JTA, Suen TKD, Kwong A
Affiliation :
Department of Surgery, Queen Mary Hospital and Tung Wah Hospital
Keyword 1: :
crepe bandage
Keyword 2: :
Breast cancer surgery
Keyword 4: :
Drain output & length of drain use
Keyword 5: :
Seroma formation
Introduction :
Prolonged usage of drainage following mastectomy may have chance of increased incidence of wound infection, dislodgment of drainage and patient discomfort. Reducing drainage volume and duration could enhance recovery and improve patient experience.
Objectives :
To evaluate whether compression dressing reduces surgical drain output and duration following mastectomy.
Methodology :
This randomized controlled trial was conducted across two Hong Kong public hospitals among patients undergoing mastectomy with or without axillary surgery during the period of January to October 2024. Patients were randomized to receive either standard care or compression dressing with crepe bandages applied postoperatively by breast care nurses (BCNs). Regular follow-up assessed compliance and complications.
Result & Outcome :
Result: Of fifty-nine mastectomies in fifty-six patients recruited, thirty were randomized to the intervention group and twenty-nine to the control group. Compliance was suboptimal in ten intervention group subjects with no crossover in controls. Causes of suboptimal compliance is due to skin problems such as itchiness or abrasion (n=8); and subjectively impaired breathing or tightness of compression (n=2). Baseline characteristics (age, body mass index, premorbid diseases; operation duration, cancer staging, number of axillary lymph node removed and receiving neo-adjuvant therapy) were comparable between two groups. Intention-to-treat (ITT) analysis revealed no statistically significant differences between groups in seroma incidence, 40% in intervention group versus 30% in control group (p=0.472); total drain output (median: 301mL [IQR 201.5–505.5] in the intervention group versus 442mL [IQR 279–651] in the control group (Mann-Whitney U = 320, p = 0.083) or duration of drain use (median: 9.5 days [IQR 8.0–15.5] versus 13.0 days [IQR 10.0–16.0], U = 337, p = 0.137). Per-protocol analysis (intervention compliance subgroup, n=20) showed significant reduced drain output (median: 296 mL [IQR 199–391], U = 189, p = 0.041) and shorter drainage duration (median: 9.0 days [IQR 7.5–12.2], U = 178, p = 0.023). Multivariate analysis identified that bandage compliance, lower body mass index, and absence of neoadjuvant therapy as independent predictors of reduced drain output and duration. Conclusion: Compression dressing significantly reduces drain output and duration after mastectomy among compliant patients. Good adherence is crucial to ensure clinical effectiveness. Patient discomfort associated with crepe bandage application should be taken into consideration. It is recommended to apply crepe bandage for patients with higher body mass index or have undergone neo-adjuvant treatment. Further direction is to design a compression device that can enhance patient’s compliance.
