Comparison Timing of Drain Removal Between Tube Rubber and Penrose in Patients with Deep Neck Infection.

Abstract

Deep neck infection is commonly found in hospitals of all areas of Thailand. The disease progression is fairly rapid and can cause severe complications or even fatality. This retrospective analysis aimed to identify characteristics of deep neck infected patients and compare timing of drain removal in these patients who had Penrose drain (non irrigation) or tube rubber drain (irrigation) after surgical incision and drainage in Buengkan hospital during January 2016 – July 2021. Data was analyzed by using descriptive statistics, Chi-square, Independent T-Test and Mann-Whitney U test were used to compare difference between Penrose drain and tube rubber drain usage group. 92 patients were studied by inclusion criteria. Thirty five patients had received Penrose drain, whilst, 57 patients had received tube rubber drain in which saline irrigation at least 200 ml (one or two times per day). These patients in both groups had never shortened the drain prior to removal.

  Results; most of patients were male (59.8%) with mean age 49.8 years old (SD=15.1). The most common underlying diseases were Diabetes Mellitus with hypertension (51.0%). Common presenting symptoms were fever with mental/cheek swelling (83.7%). The most common site of infection was submandibular space (32.6%) caused by odontogenic infection (70.7%). Common pathogens were Staphylococcus spp./Streptococcus spp. (7.6%) and Burkholderia pseudomallei (7.6%). The patients had treated by surgical incision and drainage with tooth extraction (31.5%). The most common complications were electrolyte imbalance and septic shock (7.6% and 5.4% respectively). Most of them had good recovery (93.4%). An average time for drain removal was 7.1 days (SD=5.8) in Penrose drain group, whereas, 6.0 days (SD=3.3) in tube rubber drain group (p=0.145). Furthermore, median of drain removal time in patient tube rubber drain group who had deep neck infected more than 1 space was 7.4 (IQR 4.6) days and 9.0 (IQR 3.4) days in Penrose drain group. There was significant difference in timing of drain removal between the two groups. (p = 0.003). An average length of stay in hospital in Penrose drain was 7.1 days (SD=4.6), in tube rubber drain was 6.8 days (SD=4.2). There was no significant difference in mean length of stay in hospital between the two groups (p = 0.170).

  Conclusion; Thus surgical incision and drainage together with tooth extraction, given antibiotics were vital to improve the length of stay in hospital for deep neck infection patients. Patients who had deep neck infection should appropriately selection with surgical drain for a better recovery.