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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1814758
Research Article

A Comparative Analysis of 4-, 12-, and 24-hour Intervals of Drain Clamping Reduces Postoperative Blood Loss Following Posterior Spinal Surgery in Adolescent Idiopathic Scoliosis: A Prospective Randomized Controlled Trial

Authors

  • Tinnakorn Pluemvitayaporn 

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Warot Ratanakoosakul

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Suttinont Surapuchong

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
    2   Research Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Piyabuth Kittithamvongs

    2   Research Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Kitjapat Tiracharnvut

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Chaiwat Piyasakulkaew

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand

  • Sombat Kunakornsawat

    1   Spine Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand
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Abstract

Study Design

The study was designed as a prospective randomized controlled trial.

Background

Posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is frequently associated with substantial blood loss, often requiring blood transfusion. To reduce postoperative blood loss, drain clamping is considered a viable technique to enhance hemostasis; however, the optimal time intervals for applying postoperative drain clamping remain uncertain.

Aims

The aim of the study is to analyze and compare the volume of postoperative blood loss following 4-, 12-, and 24-hour drain clamping intervals in AIS patients undergoing posterior spinal fusion.

Materials and Methods

Patients diagnosed with AIS who underwent posterior spinal surgery between 2021 and 2024 were recruited for the study. The patients were allocated in a 1:1:1 ratio to 4-, 12-, or 24-hour intervals of drain clamping. The primary outcome was cumulative drain output until removal. Secondary outcomes included intraoperative blood loss, blood loss per fused level, transfusion rate, postoperative change in hemoglobin, Cobb angle correction, and complications. Analyses followed the intention-to-treat principle.

Results

Ninety patients were enrolled in this study. Mean cumulative drain output was 1,374 ± 339.8 mL in the 4-hour interval group, 1,325 ± 467.6 mL in the 12-hour interval group, and 1,472 ± 286.3 mL in the 24-hour interval group (p = 0.30). Intraoperative blood loss (p = 0.47), blood loss per fused level (p = 0.54), and transfusion rates (p = 0.63) were comparable. No hematomas, surgical site infections, or delayed wound healing were observed up to 24 months. Minor complications included one case of adhesive bandage irritation (12-hour interval group) and two cases of superficial wound dehiscence (24-hour interval group).

Conclusion

Drain clamping at 4-, 12-, or 24-hour intervals did not significantly alter postoperative blood loss or transfusion requirements. A 4-hour interval drain clamping appears sufficient, balancing hemostatic benefit with safety.

Keywords

blood loss - spinal surgery - adolescent idiopathic scoliosis - drain clamping - clamping intervals

Authors' Contributions

All authors contributed to the study's conception and design. T.P., S.S., and W.R. did the material preparation, data collection, and analysis. T.P. wrote the first draft of the manuscript and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript. T.P., W.R., S.S., P.K., K.T., C.P., and S.K. conducted the study design, manuscript writing, and editing, approved the version to be published, and agreed to be accountable for all aspects of work.


Ethical Approval

The study was approved by the Ethics Committee of Lerdsin Hospital.




Publication History

Article published online:
14 January 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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