title: Necessity of subcutaneous suction drains in ileostomy reversal (DRASTAR)-a randomized, controlled bi-centered trial.
abstract: OBJECTIVE
  Data regarding length of hospital stay of patients undergoing ileostomy reversal are very heterogeneous. There are many factors that may have an influence on the length of postoperative hospital stay, such as postoperative wound infections. One potential strategy to reduce their incidence and to decrease hospital stay is to insert subcutaneous suction drains. The purpose of this study was to examine the influence of the insertion of subcutaneous suction drains on hospital stay and postoperative wound infections in ileostomy reversal. Risk factors for postoperative wound infection were determined.
  
  
  METHODS
  This is a randomized controlled two-center non-inferiority trial with two parallel groups. The total length of hospital stay as primary endpoint and the occurrence of a surgical site infection, the colonization of the abdominal wall with bacteria, and the occurrence of hematomas/seromas as secondary endpoints were monitored.
  
  
  RESULTS
  One hundred eighteen patients with elective ileostomy reversal were included. Fifty-nine patients were randomly assigned to insertion of a subcutaneous suction drain, and 59 patients were randomly assigned to receive no drain. After 3 months of follow-up, 50 patients in the group with drain and 53 patients in the group without drain could be analyzed. Median total length of hospital stay was 8 days in the SD group and 9 days in the group without SD (p = 0.17). Fourteen percent of patients with SD and 17 % without SD developed SSI, p = 0.68. Multivariate analysis revealed anemia (p < 0.01), intraoperative bowel perforation (p = 0.02) and resident (p = 0.04) or fellow (p = 0.048) performing the operation as risk factors for SSI.
  
  
  CONCLUSIONS
  This trial shows that the omission of subcutaneous suction drains is not inferior to the use of subcutaneous suction drains after ileostomy reversal in terms of length of hospital stay, surgical site infections, and hematomas/seromas.
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. johannes.lauscher@charite.de.
authors.forename: J C
authors.initials: JC
authors.lastname: Lauscher
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Schneider
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: L D
authors.initials: LD
authors.lastname: Lee
authors.affiliation: Institute of Biometry and Clinical Epidemiology, Charité Campus Mitte, Charitéplatz 1, 10098, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stroux
authors.affiliation: German Society for General and Visceral Surgery, Schiffbauerdamm 40, 10117, Berlin, Germany.
authors.forename: H J
authors.initials: HJ
authors.lastname: Buhr
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: M E
authors.initials: ME
authors.lastname: Kreis
authors.affiliation: Department of General and Visceral Surgery, HELIOS Kliniken Schwerin, Wismarsche Straße 393-397, 19049, Schwerin, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Ritz
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D012307:Risk Factors; D013396:Suction / Q000295:instrumentation; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
keywords: Hospital stay; Ileostomy closure; Subcutaneous suction drains; Surgical site infection