Risk factors for increased surgical drain output in patients after unilateral expansive open-door cervical laminoplasty for cervical compressive myelopathy: A retrospective study of 341 patients

Hongwei Wang; Shuang Zhai; Zhihao Zhang; Hongwen Gu; Shanshan Liu; Yin Hu; Kangen Han; Junchao Li; Le Xing; Ming Huang; Yongcun Wei; Hong Yuan; Hailong Yu

doi:10.1016/j.wneu.2025.124271

Risk factors for increased surgical drain output in patients after unilateral expansive open-door cervical laminoplasty for cervical compressive myelopathy: A retrospective study of 341 patients

World Neurosurg. 2025 Jul 11:124271. doi: 10.1016/j.wneu.2025.124271. Online ahead of print.

Authors

Hongwei Wang¹, Shuang Zhai², Zhihao Zhang¹, Hongwen Gu¹, Shanshan Liu¹, Yin Hu¹, Kangen Han¹, Junchao Li¹, Le Xing¹, Ming Huang³, Yongcun Wei¹, Hong Yuan¹, Hailong Yu⁴

Affiliations

¹ Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, 110016, China.
² Department of Outpatient, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, 110016, China.
³ Department of Anesthesiology, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, 110016, China.
⁴ Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, 110016, China. Electronic address: yuhailong_gh2022@163.com.

PMID: 40653014
DOI: 10.1016/j.wneu.2025.124271

Abstract

Objective: This study aimed to investigate determinants independently correlated with increased surgical drain output (ISDO) observed following unilateral expansive open-door cervical laminoplasty (UEOCL) procedures performed in individuals diagnosed with cervical spondylotic myelopathy (CSM).

Methods: This retrospective cohort study analyzed medical records from a single tertiary care center spanning January 2013 to December 2019 to identify individuals undergoing UEOCL with prophylactic drainage. Cases were stratified into two cohorts based on cumulative drainage volume, with the experimental group defined by outputs ≥500 ml (ISDO classification). Demographic characteristics, intraoperative parameters, and postoperative variables were systematically evaluated through univariate and multivariate statistical approaches to establish potential predictors of excessive fluid secretion.

Results: Among 341 eligible UEOCL cases identified through inclusion criteria screening, the mean postoperative drainage volume across the cohort measured 449.0 ± 167.1 ml. Of these, 131 subjects (38.4%) exhibited ISDO criteria, defined as drainage exceeding 500 ml. Multivariable regression analysis identified four independent predictors: male gender (p=0.011), age under 60 years (p=0.008), elevated preoperative diastolic blood pressure (p=0.039), and application of lateral mass screw fixation (p=0.001). Those meeting ISDO criteria demonstrated extended hospitalization durations (p=0.047) and increased medical expenditures (p<0.001) compared to counterparts with typical drainage volumes.

Conclusions: Multivariate analysis identified male gender, younger age (below 60 years), elevated preoperative diastolic blood pressure, and lateral mass screw fixation as independent predictors of ISDO development post-UEOCL. Furthermore, the presence of ISDO demonstrated significant correlations with prolonged hospitalization duration and elevated inpatient financial expenditures.

Keywords: cervical compressive myelopathy; risk factors; surgical drain output; unilateral expansive open-door cervical laminoplasty.