title: Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy.
abstract: OBJECTIVE
  Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy.
  
  
  METHODS
  Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management.
  
  
  RESULTS
  A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6%. Eighty-five (34.7%) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5%, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI.
  
  
  CONCLUSIONS
  This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.
authors.affiliation: Department of Colorectal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing Cancer Hospital, Fucheng Road 52, Haidian District, 100142, Beijing, China.
authors.forename: Hong-Da
authors.initials: HD
authors.lastname: Pan
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Peng
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Yun-Feng
authors.initials: YF
authors.lastname: Yao
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.forename: Tian-Cheng
authors.initials: TC
authors.lastname: Zhan
authors.forename: Chang-Zheng
authors.initials: CZ
authors.lastname: Du
authors.forename: Jin
authors.initials: J
authors.lastname: Gu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D040521:Subcutaneous Tissue / Q000473:pathology*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy*; D014618:Vacuum; D055815:Young Adult