Is a surgical drain necessary in elderly patients with femoral neck fractures treated with hemiarthroplasty? - A case-control study

Abstract Femoral neck fracture is a common osteoporotic fracture in elderly patients and is effectively managed with arthroplasty. However, the benefits and risks of surgical drain after arthroplasty in these patients are still debatable. Hence, we conducted this case-control study to investigate the necessity of surgical drain in elderly patients with femoral neck fractures treated with cementless bipolar hemiarthroplasty. This study enrolled elderly patients (aged ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between April 2016 and December 2021. The patients were classified into the control group comprising 199 patients with surgical drain after surgery performed between April 2016 and June 2020, and the study group, which comprised 134 patients with no surgical drain between July 2020 and December 2021. Demographics, perioperative data and postoperative complications were compared between the two groups. Estimated blood loss, perioperative transfusion volume and rate, and length of hospital stay were significantly lower in the study group than in the control group (p < 0.001, p < 0.001, p = 0.008, and p < 0.001, respectively). Although there were no significant intergroup differences in the length of intensive care unit stay and in-hospital, 1-month, and 1-year mortalities, the incidence of postoperative medical complications was significantly higher in the control group than the study group and the odds ratio was 2.10 (95% Confidence Interval = 1.32–3.34, p = 0.001). Surgical drain is not necessary after cementless bipolar hip hemiarthroplasty in elderly patients with femoral neck fractures, considering lower blood loss, transfusion and lower incidence of postoperative medical complications in the study group with no surgical drain.