Randomized Trial of Drain Antisepsis After Mastectomy and Immediate Prosthetic Breast Reconstruction

Abstract

Background In this two-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction. Methods With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstruction to drain antisepsis (treatment) for one side, with standard drain care (control) for the other. Antisepsis care included both: 1) chlorhexidine disc dressing at drain exit site(s), and 2) irrigation of drain bulbs twice daily with dilute sodium hypochlorite solution. Cultures were obtained from bulb fluid at one week and at drain removal, and from the subcutaneous drain tubing at removal. Positive cultures were defined as ≥1+ growth for fluid and >50 CFU for tubing. Results Cultures of drain bulb fluid at one week (the primary endpoint) were positive in 9.9% of treatment sides (10/101) versus 20.8% (21/101) of control sides (p=0.02). Drain tubing cultures were positive in 0 treated drains versus 6.2% (6/97) of control drains (p=0.03). Surgical site infection occurred within 30 days in 0 antisepsis sides versus 3.8% (4/104) of control sides (p = 0.13), and within 1 year in 3/104 (2.9%) of antisepsis sides versus 6/104 (5.8%) of control sides (p = 0.45). Clinical infection occurred within one year in 9.7% (6/62) of colonized sides (tubing or fluid) versus 1.5% (2/136) of non-colonized sides (p = 0.03). Conclusions Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains, and reduced drain colonization was associated with fewer infections.

Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

“…[3,4] However, prolonged drain duration may increase infection rate due to ascending infection. [5–7] The optimal timing of drain removal after prosthesis-based breast reconstruction is still unclear. Most surgeons (87.4%) recommend drain removal when the daily drainage volume at the time of drain removal (defined as last daily drainage volume) drops below 30 mL.…”

Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

“…SSI prevention has gained worldwide attention because of the associated medical costs and morbidity [11,14,18]. Most hospital readmissions after surgery are due to SSI [1].…”

“…Furthermore, SSI can increase the costs associated with the surgery and decrease patient satisfaction after surgery [13,14]. Thus, interventions to reduce the incidence of SSI are essential to reduce not only morbidity, but also costs to the patient and the society [11,13–19]. …”

Estudo comportamental sobre a drenagem axilar no câncer de mama

“…Entre as complicações pós-operatórias do câncer de mama, a formação de seroma permanece como a mais frequente, apresentando incidência que varia de 3 a 85% 17,18 . Além disso, o seroma também está associado a necrose cutânea, dificuldades para a cicatrização da ferida operatória, infecção local e linfedema de membro superior [18][19][20] .…”

“…Nessas situações, a abordagem do seroma inclui a utilização de diferentes sistemas de drenagem, que geralmente são inseridos de forma profilática durante o procedimento cirúrgico. Apesar das divergências envolvendo o tipo de drenagem, o tempo de permanência e o uso de antibióticos [18][19][20] , pouco se sabe sobre as repercussões psicossociais envolvendo o método. Assim, este estudo teve como objetivo a avaliação dos sentimentos e das dificuldades vivenciadas pelas pacientes durante a utilização de drenos de sucção.…”