title: Closed-suction drain placement at laparotomy in isolated solid organ injury is not associated with decreased risk of deep surgical site infection.
abstract: The purpose of this study was to investigate the role of intra-abdominal closed-suction drainage after emergent trauma laparotomy for isolated solid organ injuries (iSOI) and to determine its association with deep surgical site infections (DSSI). All patients subjected to trauma laparotomy between January 2006 and December 2008 for an iSOI at two Level I urban trauma centers were identified. Patients with isolated hepatic, splenic, or renal injuries were included. Study variables extracted included demographics, clinical characteristics, intra-abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and in-hospital mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and elevated white blood cell count. For the analysis, patients were stratified based on injury severity. To identify an independent association between closed-suction drain placement and DSSI, stepwise logistic regression analysis was performed. Overall, 142 patients met the inclusion criteria with 80 per cent (n=114) having severe iSOI. In 47 per cent (n=53) of the patients with a severe injury, an intra-abdominal drain was placed. A drain was placed more often in patients with a blunt trauma with more severe injury defined by Injury Severity Score and abdominal Abbreviated Injury Scale Score and those who underwent splenectomy (P<0.05). There was a three-fold increased risk of DSSI in patients subjected to drain placement (odds ratio, 2.8; 95% confidence interval, 1.0 to 8.2; P=0.046). Subgroup analysis demonstrated those who sustained severe hepatic injury receiving a drain had a significantly increase risk of DSSI (P=0.02). There was no statistical difference in the rate of DSSI based on the presence or absence of an intra-abdominal drain after severe splenic injury (17 vs 18%, P=0.88). The use of intra-abdominal closed-suction drains after iSOI is not associated with decreased risk of DSSI.
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 90033-4525, USA.
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013396:Suction / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*