Role of subcutaneous closed vacuum drain in preventing surgical site infection in emergency surgery for perforative peritonitis: A randomized control study

Abstract

Abstract:Objective: The aim of our study was to evaluate whether insertion of a subcutaneous closed suction vacuum drain at incisional surgical site reduces the incidence of surgical site infection (SSI) in post operative cases of exploratory laparotomy for perforative peritonitis. Methods: An institutional based randomized control study was performed with two hundred patients each included in the study (with drain) and control (without drain) group. Both groups were statistically similar in terms of various variables and thus comparable. All continuous variables were reported as mean ± SD and compared across groups using unpaired t-test. All categorical variables were reports as n (%) compared across groups using Chi-square test for independence of attributes. Result: Use of a subcutaneous closed suction vacuum drain results in statistically significant reduction in wound infection (58% vs 16%; p < 0.001). The most common organism causing SSI was found to be Escherichia Coli accounting for 62.5% and 62.7% of cases in drain group and control group respectively, followed by Klebsiella (12.5% vs 24.14%). Conclusion: Use of a subcutaneous closed suction vacuum drain is effective in reducing SSI in contaminated surgery like that for perforative peritonitis and also leads to reduction in SSI related complications like wound disruption, patient discomfort, bad cosmesis, prolonged hospital stay, antibiotic use and increased cost.

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

“…6 Kumar et al posted that the SSI incidence was 16% in patients with subcutaneous drain and 58% in patients without subcutaneous drain in patients undergoing emergency surgery for perforative peritonitis. 7 Vaghani et al in their study on ileal perforation cases found SSI rate of 25% in patients with subcutaneous drain and 57.7% in patients without subcutaneous drain. 8 El-Badry et al in his study on emergency laparotomy cases found the SSI rate to be 11% in patients with subcutaneous drain and 44% in patients without subcutaneous drain.…”

Incidence of surgical site infections after emergency laparotomy for perforation peritonitis

“…However Gupta and Kumar [19] , found that 37% patients developed surgical site infection post emergency abdominal surgery. Kumar et al [22] also found 37% patients developed surgical site infection in laparotomy for perforated peritonitis. Surgical site infection developed in15.5% of duodenal ulcer perforation, 16.7% of gastric ulcer perforation, 23.5% of traumatic small bowel perforation, 37.5% of ileal perforation and 36% of burst appendix.…”

“…Gupta and Kumar [19] , supported this result that 72% of patients were male and 38% were female. Kumar et al [22] found 58.0% of patients were male and 42.0% of cases were female. The most common perforation peritonitis was duodenal ulcer perforation (28.9%), followed by burst appendix (27.8%), traumatic small bowel perforation (18.9%), ileal perforation (17.5%) and gastric ulcer perforation (6.7%).…”

“…Patel et al [21] found the pathology in decreasing order was peptic perforation (40%), enteric perforation (27%), colorectal pathology (13%), perforated appendix (10%) and gall bladder pathology (10%). Kumar et al [22] found peptic perforation (34%), enteric perforation (21%), colorectal (11%), perforated appendix (23%) and jejunum (21%). In this study surgical site infection developed in 26.7% of patients.…”

“…Gupta and Kumar [19] , supported this result that the incidence of surgical site infection in drain group was lower than the no drain group, which was statistically significant (p<0.05). Kumar et al [22] found that the use of a subcutaneous closed suction vacuum drain resulted in statistically significant reduction in wound infection (58% vs. 16%) with a p value of <0.001). This study was not without limitations.…”