Excision of a submandibular gland: a safe day case procedure?

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Abstract

There are considerable benefits, both for patients and hospitals, if operations are done as day case procedures. Excision of a submandibular gland is a relatively common operation and it is usual practice for surgeons to be cautious, admit the patient for an overnight stay, and leave a drain in place. To assess the amount of postoperative bleeding into the wound (and hence potential risk to the airway) we have studied prospectively the amount of drainage that occurs. Sixty consecutive patients admitted for overnight postoperative monitoring after excision of a submandibular gland had a suction drain placed as part of the procedure. Drainage was measured by departmental staff at regular intervals during the following 24 h. Nearly all the patients drained 40 ml or less (mean 18 ml) and in all cases there was a clear decrease in the volumes drained over the first 6–8 h postoperatively. Drainage then became negligible. The plateau in drainage was evident regardless of the initial volume drained. Surgeons should be confident that drainage will cease after 6–8 h in most patients, and residual drainage is negligible.

Introduction

There are considerable benefits if operations are done as day case procedures rather than patients being admitted to a ward for an overnight stay,1 and during the early 1990s there was an increase in the use of day surgery and provision of facilities. This tailed off towards the end of the decade but, after an Audit Commission Report in 2001, there was an expectation within the Department of Health that three-quarters of all elective operations would be done as day case procedures.2 This goal was based on a list of operations, initially involving 20 procedures3 and then extended to 25,2 developed by the Audit Commission and covering the most common procedures in all the major specialties. The British Association of Day Surgery (BADS) has broadened the scope of this list by adding a further 17, with the expectation that at least half of these more major procedures could be treated within day surgical units.4

Excision of the submandibular gland, a relatively common operation, is included in the extended BADS’ list of procedures. It is done for both neoplastic and benign conditions, the most common being chronic sialadenitis or sialolithiasis.5, 6 Because of a perceived risk to the airway from any postoperative swelling, it is usual practice for surgeons to be cautious, put a drain in place, and admit the patient for an overnight stay. To assess the amount of postoperative bleeding, and hence the potential risk to the airway, we have studied prospectively the amount of drainage after excision of a submandibular gland.

Section snippets

Method

Sixty consecutive patients admitted for overnight postoperative monitoring after excision of a submandibular gland had a suction drain placed during the operation. Drainage was measured by departmental staff regularly during the next 24 h, at which point the drain was removed.

Permission was not sought from the ethics committee because there was no change in management. There were no exclusion criteria. The operations were done by two surgeons, and the surgical techniques, the drain used, and

Results

There were 24 men and 36 women, age range 20–87 years. The drainage was measured 1, 2, 4, 6, 8, and 12 h postoperatively. The final measurement was made when the drain was removed after 24 h. The results show a clear trend in the pattern of drainage. In nearly all the patients the drainage volume plateaued within 8 h, with negligible drainage thereafter (Fig. 1).

Discussion

Fifty-seven of the patients drained 40 ml or less (mean18 ml) and in all cases the volumes lessened over the first 6–8 postoperative hours. After this it became negligible, and the drain provided little further function. The plateau was evident regardless of the initial volume that drained. Surgeons should be confident that drainage will cease after 6–8 h in most patients, and that residual drainage is negligible.

Only three patients had a total drainage volume of more than 40 ml, two of whom were

Conflict of interest

The authors wish to declare that there is no conflict of interests.

References (7)

  • S.F. Preuss et al.

    Submandibular gland excision: 15 years of experience

    J Oral Maxillofac Surg

    (2007)
  • Treat day surgery rather than inpatient surgery as the norm for elective surgery: operational guide

    (2002)
  • Audit Commission

    Day surgery: acute hospital portfolio review of national findings, No. 4

    (2001)
There are more references available in the full text version of this article.

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c

Formerly at Department of Maxillofacial Surgery, Ninewells Hospital, Dundee, United Kingdom.

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