Penrose drains are the most commonly used type of drain in veterinary practice, being readily available, easy to place and inexpensive (Watson and McFadden, 2019). These drains are typically used to eliminate dead space and remove or prevent fluid or gas from accumulating in wounds (Watson and McFadden, 2019; Charlesworth and Sampaio, 2023).
However, despite their widespread use, there is no clear guidance for surgeons on whether to keep canine patients in the hospital for Penrose drain care or discharge them with the drain in place (Charlesworth and Sampaio, 2023). Further, to date, there has been no data on the effect of duration of hospitalisation on the risk of surgical infection and complications or on infection rates in dogs discharged home with drains. Instead, this decision is dependent on the personal experience and perception of different surgeons, weighing up the advantages and disadvantages of increased hospitalisation.
Despite their widespread use, there is no clear guidance for surgeons on whether to keep canine patients in the hospital for Penrose drain care or discharge them with the drain in place
A recent study by Tim Charlesworth and colleague, published in the Journal of Small Animal Practice, addresses this knowledge gap by comparing the complication and infection rates between dogs hospitalised for Penrose drain care and those that recovered at home with the drain in situ. This information can guide recommendations for an optimal post-operative regime for patients.
The study
In the latest study, the researchers retrospectively searched medical records from 2014 to 2022 for dogs that had a Penrose drain placed into a wound at the authors’ institution – a referral hospital in the UK. Cases were then divided into those discharged home with a drain in place, those discharged only after drain removal and those who recovered part of the time in hospital and part at home with the drain in place (Charlesworth and Sampaio, 2023).
In total, 208 dogs were included in the study. Most dogs had a Penrose drain placed using a “traditional” surgical technique, whereby the proximal edge of the Penrose drain is placed into the deepest dorsal portion of the wound and tethered either by an absorbable suture to the underlying wound or by a suture placed from the skin surface through the drain and back out of the skin. The distal end of the drain is exited through a single separate ventral incision greater in length than the diameter of the drain and a suture placed between the distal portion of the drain and the skin at the exit point. Drains were placed:
- After traumatic wound repair, such as lacerations, foreign body retrieval or bite wounds (43 percent of cases)
- Following mass resection (30 percent of cases)
- Into abscess cavities (19 percent of cases)
- After sialoadenectomy for treatment of salivary mucocele (9 percent of cases)
The findings
There was no significant difference in infection rate between dogs hospitalised for drain care and those sent home with drains in situ, with an overall wound infection rate of 16.9 percent. This varied between 18.4 percent in dogs kept hospitalised, 16.2 percent in dogs discharged home within 24 hours and 22.2 percent in dogs discharged home after being hospitalised for more than 24 hours.
There was no significant difference in infection rate between dogs hospitalised for drain care and those sent home with drains in situ, with an overall wound infection rate of 16.9 percent
Similarly, there was no significant difference in complication rates. The overall complication rate was 40.9 percent: 42.9 percent for dogs hospitalised, 39 percent for dogs cared for at home and 50 percent for those discharged home after being hospitalised for more than 24 hours. Most complications were considered minor and included seroma, purulent discharge, wound dehiscence, persistent serosanguinous discharge following drain removal, bruising, self-trauma and premature drain removal.
The conclusion
The similar infection and complication rates between dogs hospitalised for drain care and those that recovered at home supports dogs being able to be discharged home for recovery. Other patient factors, including the presence of comorbidities, should be prioritised in this decision.
Keeping a patient hospitalised offers the advantages of close supervision by veterinary professionals and hopefully decreases the risk of self-trauma and premature removal or interference with the drain. It does, however, lead to increased cost to the client and potentially increased patient stress.
The limitations
The study was limited in its retrospective nature, which means the data was not always consistently recorded. Specifically, data on the use of barrier-type wound protection was absent in many cases, the level of owner/patient compliance in measures to avoid patient trauma to the drain was not always clearly recorded and the use of dispensed protective equipment for all patients was not consistently recorded.
Take-home message
Dogs can be discharged home to recover with a Penrose drain in place when deemed appropriate, based on factors other than drain-associated complications
As this study showed no significant difference between the rates of complication or infection for hospitalised dogs and those sent home for ongoing Penrose drain care, it suggests that dogs can be discharged home to recover with a Penrose drain in place when deemed appropriate, based on factors other than drain-associated complications.
