Prevention of incisional surgical site infection by subfascial closed suction drainage after open laparotomy: a single surgeon experience in 250 consecutive patients

Abstract

Background Open laparotomy with gastroenterological surgery is a surgical procedure results in a relatively high rate (about 10% or more) of incisional surgical site infection (SSI). To reduce incisional SSI after open laparotomy, mechanical preventors, such as subcutaneous wound drainage or negative-pressure wound therapy (NPWT), have been tried; however, conclusive results have not been obtained. This study evaluated the prevention of incisional SSI by first subfascial closed suction drainage after open laparotomy. Methods A total of 453 consecutive patients who underwent open laparotomy with gastroenterological surgery by one surgeon in one hospital (between August 1, 2011, and August 31, 2022) was investigated. Same absorbable threads and ring drapes were used in this period. Subfascial drainage was used in consecutive 250 patients in the later period (between January 1, 2016, and August 31, 2022). The incidences of SSIs in the subfascial drainage group were compared to those of in the no subfascial drainage group. Results (a) No incisional SSI (superficial and deep) occurred in the subfascial drainage group (superficial = 0% [0/250] and deep = 0% [0/250]). As a result, incidences of incisional SSI of the subfascial drainage group were significantly lower than those of the no subfascial drainage group (superficial = 8.9% [18/203]; deep = 3.4% [7/203]) (p < 0.001 and p = 0.003, respectively). (b) Four out of seven deep incisional SSI patients in the no subfascial drainage group underwent debridement and re-suture under lumbar or general anesthesia. (c) There was no significant difference in the incidences of organ/space SSI of the two groups (3.4% [7/203] in the no subfascial drainage group and 5.2% [13/250] in the subfascial drainage group) (P = 0.491). Conclusion Subfascial drainage was associated with no incisional SSI after open laparotomy with gastroenterological surgery.

A meta‐analysis of the risk factors for surgical site infection in patients with colorectal cancer

“…The sample size was 60–67 613 people. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Clean‐contaminated surgical site wounds had a significantly lower infection compared to contaminated surgical site wounds in patients with CCs. Males had significantly higher SSIs compared to females in patients with CCs.…”

“…23 tests that were published between 2001 and 2023 were included in the meta‐analysis after an evaluation of 2309 applicable studies since they fit the inclusion criteria 23–45 . Table 2 summarizes the findings of these investigations.…”

“…23 tests that were published between 2001 and 2023 were included in the meta‐analysis after an evaluation of 2309 applicable studies since they fit the inclusion criteria. 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Table 2 summarizes the findings of these investigations. 89 859 people with CCs were in the used studies' starting point, and 7548 of them had SSIs.…”

“…For the current meta‐analysis, 23 examinations from 2001 to 2023 were included; of these, 89 859 individuals with CCs were included in the beginning point of the used investigations, and 7548 of them had SSI. The sample size was 60–67 613 people 23–45 . Clean‐contaminated surgical site wounds had a significantly lower infection compared to contaminated surgical site wounds in patients with CCs.…”