title: Closed suction drain after isolated hollow viscus injury: a friend or foe?
abstract: BACKGROUND
  The objective of this study was to investigate associations between closed suction intra-abdominal drain placement in isolated hollow viscus injury (HVI) and intra-abdominal deep surgical site infections (DSSI).
  
  
  METHODS
  Patients undergoing emergent trauma laparotomy at a Level I trauma center after isolated HVI from January 2006 to December 2008 were identified. Study variables extracted from institutional trauma registry and patient electronic medical records included demographics, clinical characteristics, abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and increased white blood cell count. Patients were analyzed according to the HVI severity and the type of intervention performed: primary repair versus resection and primary reanastomosis. To identify independent associations between surgical management of HVI and DSSI, logistic regression analysis was used.
  
  
  RESULTS
  Overall, 131 patients met the study criteria; 20% (n = 26) received an intra-abdominal drain. The incidence of DSSI was significantly higher in patients who received a drain (31% vs. 9%, p = 0.001). No associated risk for development of DSSI in patients who underwent drain placement after primary repair versus resection and primary reanastomosis was demonstrated. Stepwise logistic regression analysis identified the following independent risk factors for development of DSSI: drain utilization (adjusted odds ratio, 3.7; 95% confidence interval, 1.15-11.9; p < 0.028), and Injury Severity Score ≥16 (adjusted odds ratio, 5.6; 95% confidence interval, 1.9-16.9; p < 0.002). In-hospital survival was unchanged with respective interventions.
  
  
  CONCLUSIONS
  Intra-abdominal drain placement after isolated HVI repair is associated with almost fourfold adjusted increased incidence of DSSI. Prospective validation of drain utilization in these instances is warranted.
authors.affiliation: Division of Acute Care Surgery (Trauma Emergency Surgery and Surgical Critical Care), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. peep.talving@surgery.usc.edu
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Bernardino Castelo
authors.initials: BC
authors.lastname: Branco
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D015998:Abbreviated Injury Scale; D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D016009:Chi-Square Distribution; D004322:Drainage / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D012042:Registries; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome