title: A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection.
abstract: BACKGROUND
  Despite the putative advantages conferred by closed-suction drains (CSDs), the widespread utilization of post-operative drains has been questioned due to concerns regarding both efficacy and safety, particularly with respect to the risk of surgical site infection (SSI). Although discipline-specific reports exist delineating risk factors associated with SSI as they relate to the presence of CSDs, there are no broad summary studies to examine this issue in depth.
  
  
  METHODS
  The pertinent medical literature exploring the relationship between CSDs and SSI across multiple surgical disciplines was reviewed.
  
  
  RESULTS
  Across most surgical disciplines, studies to evaluate the risk of SSI associated with routine post-operative CSD have yielded conflicting results. A few studies do suggest an increased risk of SSI associated with drain placement, but are usually associated with open drainage and not the use of CSDs. No studies whatsoever attribute a decrease in the incidence of SSI (including organ/space SSI) to drain placement.
  
  
  CONCLUSIONS
  Until additional, rigorous randomized trials are available to address the issue definitively, we recommend judicious use and prompt, timely removal of CSDs. Given that the evidence is scant and weak to suggest that CSD use is associated with increased risk of SSI, there is no justification for the prolongation of antibiotic prophylaxis to "cover" an indwelling drain.
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York 10065, USA.
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Reiffel
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
authors.forename: Jason A
authors.initials: JA
authors.lastname: Spector
mesh_terms: D004322:Drainage / Q000009:adverse effects*; D006801:Humans; D013396:Suction / Q000009:adverse effects*; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology*