A Multi-Disciplinary Review of the Potential Association between Closed-Suction Drains and Surgical Site Infection

Abstract

Background: Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth. Methods: The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed. Results: Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement. Conclusions: Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to ''cover'' an indwelling drain.

Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

“…Prolonged wound drainage and other signs of superficial infection should alert the treating surgeon and prompt to further diagnostic testing and management [ 8 ]. It should be noted that, even though a direct association between the use of drains and the risk for SSI after THA has not been proven [ 13 ], it is recommended that drains should be removed in a timely fashion [ 44 ].…”

Prevalence of surgical site infection in general surgery in a tertiary care centre in India

“…Drains are placed commonly in the operative setting to prevent abscess or hematoma formation and are hypothesized to lead to surgical site infection (SSI) via external or luminal contamination and subsequent inward (retrograde) bacterial migration along the drain surface. 27 In contrast to passive (open) drains, closed-suction drains (CSDs) establish a pressure gradient between the wound and the external environment and empty into a sealed reservoir, and are believed to reduce the risk of retrograde microbial contamination. Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine postoperative CSD have yielded conflicting results.…”

Postoperative Complications of Suction Drain in Patients Submitted to 1-Level Lumbar Arthrodesis

“…20 The formation of seroma is defined as any clinical evaluation of fluid collection that requires local aspiration. 21 According to Reiffel et al, 22 there is no significant difference in seroma formation between groups with the use or not of suction drains, but there is a higher incidence in the with drain group as a result of the inflammatory process caused in reaction to a foreign body.…”