Intraperitoneal drains move

Surgical site infections (SSIs) lead to substantial mortality, morbidity, and socioeconomic loss. To explore the rate of infections and risk factors for the development of infection in surgical units. Materials and methods: All patients (n = 1397) who underwent a surgical intervention and were hospitalized for >48 h in surgical units (except the ophthalmology unit) of Gaziantep University Medical Faculty Hospital between 17 March 2008 and 15 July 2008 were included in the study. The Center for Disease Control and Prevention criteria were used for identifying and diagnosing SSIs. Rate of SSI was calculated as the number of SSIs observed after every 100 surgical procedures. Potential risk factors for SSIs were evaluated by multivariate logistic regression model. Results: SSIs occurred in 131 (9.4%) of the 1397 patients during this period. SSIs extended length of stay by 12.8 days. In the multivariate logistic regression analysis, diabetes mellitus (OR: 2.660, CI: 1.389-5.093), use of surgical drains (OR: 3.706, CI: 1.910-7.191), perioperative transfusion (OR: 1.787, CI: 1.077-2.965), trauma (OR: 2.244, CI: 1032-4.880), reoperation (OR: 7.408, CI: 3.315-16.555), contaminated (OR: 3.291, CI: 1.433-7.556) or dirty-infected (OR: 3.451, CI: 1.888-6.310) wound types, and each point increase in the National Nosocomial Infection Surveillance (NNIS) risk index (OR: 7.499, CI: 4.336-12.967) were detected as independent risk factors for developing SSIs. Conclusion: In an effort to decrease SSI rate, risk factors should be determined and essential measures should be implemented regarding preventable factors. In this context, the excess transfusion of blood and blood products and unnecessary use of surgical drains should be avoided, and surgical drains should be removed as soon as possible. In addition, traditional wound classification and NNIS risk index may be used in the prediction of SSIs.

Breast surgery, like mastectomy, is generally considered a low-risk procedure for surgical site infections (SSIs), but when SSIs do occur, they can lead to significant complications. Identifying risk factors to improve patient outcomes and minimize complications is essential. Objective: This study aimed to determine the frequency of post-mastectomy surgical site infections (SSI) in premenopausal females with breast carcinoma and to identify the associated risk factors. Methods: This descriptive case study included 100 premenopausal females diagnosed with breast carcinoma who underwent mastectomy at a tertiary care hospital, Shaikh Zayed Hospital Lahore, from April 2024 to August 2024. The age range of participants was 25-45 years, with a mean age of 39 ± 5.3 years. Demographic data, including age, gender, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) score, were collected. Intraoperative variables such as blood loss (mean: 350 ± 50 ml) and surgery duration (mean: 120 ± 15 minutes) were also recorded. All patients received standard postoperative antibiotic prophylaxis, including cefazolin or clindamycin, for those allergic to penicillin. The surgical site was assessed 30 days postoperatively for signs of infection, including erythema, pus discharge, or fever exceeding 38°C. SSIs were categorized based on the Centers for Disease Control and Prevention (CDC) guidelines into superficial, deep, and organ/space infections. Results: The overall infection rate was 7.5% (n=7). Of these, 4 cases were superficial infections, while 3 involved deeper tissue layers, requiring drainage and further antibiotics. Factors significantly associated with an increased risk of disease in the multivariate logistic regression model included a high wound class (contaminated or dirty; OR: 3.2, p=0.01), elevated ASA score (ASA III-IV; OR: 2.8, p=0.03), high BMI >30 (OR: 3.5, p=0.002), diabetes (OR: 4.1, p=0.001), use of surgical drains (OR: 2.9, p=0.02), and reoperation (OR: 4.3, p=0.005). The mean hospital stay was extended by 4.5 days (from 5.2 ± 1.5 days in non-infected patients to 9.7 ± 3.1 days in infected cases). Conclusion: The study found a post-mastectomy surgical site infection rate of 7.5% in premenopausal females, with significant risk factors including high BMI, diabetes, use of surgical drains, and the need for reoperation. A high wound class and elevated ASA score also predicted increased infection risk. Addressing these modifiable risk factors through optimized perioperative care, such as better glycemic control, judicious use of surgical drains, and minimizing reoperations, may help reduce SSI rates and improve outcomes for breast cancer patients.

Background: Surgical site infections can be a severe complication associated with an increase in mortality following coronary artery bypass graft surgery. We performed a study to determine risk factors for the development of SSI and to set up prevention strategies in the management of these patients. Methods: Case-control study at a 302-bed, teaching hospital. Case-patients with surgical-site infection occurring up to 1 month following coronary artery bypass grafting performed between January 2000 and December 2010 were identified prospectively by hospital epidemiologist using National Nosocomial Infections Surveillance (NNIS) System methods. Two control-patients were selected for each case-patient, matched by date of surgery. Results: Eighty-seven patients with infections (65 superficial and 22 deep) were identified. Logistic regression analysis identified tree variables independently associated with the development of infection: diabetes mellitus (OR, 1.9; 95% confidence interval [95% CI], 1.0 to 3.8.; P = 0.05), a NYHA class IV score (OR, 3.4; 95% CI, 1.8 to 8.4; P = 0.0001) and the use of surgical drains (OR, 1.2; 95% CI, 1.1 to 1.4; P = 0.0001). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various co morbidities, surgeon, duration and type of procedure, or other invasive procedures. Conclusion: The use of closed suction drainage, diabetes mellitus and a high NYHA score were associated with the development of surgical-site infection following coronary artery bypass grafting. Avoiding the use of surgical drains and careful monitoring of blood glucose in patients undergoing coronary artery bypass grafting should reduce the risk of infection.

IntroductionPercutaneous drains can be associated with several complications, including infection, fistula formation, discomfort and prolonged hospitalization. ObjectiveThe aim of this study was to evaluate the safety of submandibular gland excision without the use of surgical drains. MethodsWe analyzed the surgery time, postoperative complications such as bleeding, facial palsy, seroma, and repeat exploration of wounds and duration of the hospital stay. Excision of the submandibular gland via a transcervical approach was undertaken by two surgeons. Prior to wound closure, the skin flap and wound bed were approximated using hemostatic fibrin glue (Greenplast-Q PFS KIT®, GC Greencross, Youngin, Korea). Neither saline irrigation nor insertion of a percutaneous drain were included. ResultsA total of 23 patients underwent submandibular gland excision. The study group consisted of 14 men (60.8%) and 9 women (39.2%) (mean age, 47.6 years; range, 24–70 years). There were two patients who had minor complications. One patient showed minor bleeding on the skin incision line immediately postoperatively, and one developed a seroma at 7 days postoperatively. There were no major surgical complications. Total duration of the surgery from skin incision to closure averaged 44.86minutes. Mean duration of the hospital stay was 3.17 days. Patients were discharged on average at 1.17 days after surgery. ConclusionThe submandibular gland can be safely excised without the use of a surgical drain, therefore allowing early patient discharge.

Drain Placement Does Not Increase Infectious Complications After Retromuscular Ventral Hernia Repair with Synthetic Mesh: an AHSQC Analysis

The routine use of surgical drains in elective hip arthroplasty has been abandoned. Also in acute hip arthroplasty for femoral neck fractures drain use reduces. Question is, whether this is justified in geriatric patients, where the incidence of anticoagulation use is high. Therefore, the aim of this study is to compare the clinical outcomes in patients with and without the use of a wound drain after hip hemiarthroplasty. Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records at two level II trauma centers between January 1st 2010 and May 16th 2016. Patients with a femoral neck fracture requiring hip hemiarthroplasty were included in the study. This study cohort included 900 patients (68% female), with a median age of 83.5 (IQR 78-88), of which 544 (60%) had a wound drain. Patients with a wound drain needed more days to be ready for discharged (10.0days (SD ± 43.3), P = < 0.001) compared to patients without a drain (5.3days (SD ± 4.2). With a drain more hemoglobin loss was found, 2.66g/dL versus 2.4g/dL (P = 0.008) and also more packed cells were supplemented, 0.29 versus 0.13 (P = 0.0016). Wound drain placement showed a statistically significant inverse relation with post-operative hematoma; odds ratio (OR 0.61, 95% CI 0.39; 0.94, P = 0.024), but no reduced risk of post-operative deep surgical site infection, (OR 1.09, 95% CI 0.43; 2.72, P = 0.862). Surgical drain placement was not associated with a reduced risk of post-operative deep surgical site infections, nor one-year mortality. However, a decreased risk of post-operative wound hematoma was observed. Furthermore, patients with a drain needed more days to be ready for discharge, show more hemoglobin loss and need more packed cell supplementation during admission.

The use of surgical drains is commonplace in all types of surgical procedures, and rarely do we take the time to contemplate or investigate the origins of these critical devices. Every surgeon should be familiar with the Jackson-Pratt drain and Blake drain, 2 of the most frequently used closed suction, negative-pressure drainage devices in surgery. These drains are used throughout the body in a wide variety of surgical procedures. The development and differences between these 2 devices are seldom known by the practicing surgeon. In this article, we delve into the ancient history of drains, the creation and alterations of the closed suction, negative-pressure drain that paved the way for the Jackson-Pratt and Blake drain. Finally, we will discuss the variety of reservoirs that attach to these drains and the origin of the well-known adage of when to pull a drain.

We conducted a prospective study of 1214 consecutive primary TKAs to compare the deep prosthetic infection rate between obese and nonobese patients during the first 12 months after surgery. We also sought to determine whether patient or surgical variables such as comorbidities, age, gender, blood transfusion, use of surgical drains, and antibiotic-impregnated cement were predictors of subsequent prosthetic infection after primary TKA. The overall prosthetic infection rate was 1.5% (n = 18). The odds for a deep prosthetic infection were greater in patients with morbid obesity (odds ratio [OR], 8.96; 95% confidence interval, 1.59-50.63) and diabetes (OR, 6.87; 95% confidence interval, 2.42-19.56). Men were more likely to have a prosthetic infection develop than women (OR, 5.93; 95% confidence interval, 1.95-18.04) and the prosthetic infection rate was lower (OR, 0.24; 95% confidence interval, 0.06-0.95) in patients when a surgical drain was used. There were no prosthetic infections in patients with diabetes who were not obese. This compares with 11 prosthetic infections in patients who were obese and diabetic and four prosthetic infections in patients who were obese but not diabetic. Morbid obesity and obesity combined with diabetes are risk factors for periprosthetic infection after TKA. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Surgical drains are commonly used in vascular surgery to control fluid buildup and reduce postoperative complications; however, their overall benefit remains uncertain due to inconsistent findings and the absence of standardized guidelines. This systematic review aimed to evaluate the role of surgical drains in vascular procedures such as carotid endarterectomy, aortic aneurysm repair, and peripheral arterial bypass, particularly in relation to complications, wound healing, length of hospital stay, and patient recovery. A comprehensive search was conducted across PubMed, Embase, Cochrane, and Google Scholar, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included randomized controlled trials (RCTs), cohort, and case-control studies that reported on relevant clinical outcomes. Nine studies met the inclusion criteria. The findings revealed mixed results regarding the effectiveness of drains in reducing complications such as hematoma and bleeding, with some benefits noted in specific patient populations. However, an increased risk of surgical site infections was frequently observed with drain use. In certain procedures, such as abdominal aortic aneurysm repair, drains may help prevent the increase in postoperative intra-abdominal pressure, although their influence on overall recovery remains unclear. Given these variable outcomes, the routine use of surgical drains in vascular surgery cannot be universally recommended. Instead, their application should be tailored based on individual patient risk factors and the complexity of the surgical procedure. Additional high-quality studies are needed to develop clear, evidence-based guidelines for their use.

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery. Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Eligibility criteria included adult patients undergoing abdominal gastrointestinal surgery, evaluating SSI and hospital stay, directly comparing PC and DPC, and randomized controlled trials (RCT) study. Results. Of 447 published studies, there were 10 eligible RCTs, consist of 672 subjects who received DPC and 668 subjects who received PC. We found no significant difference in SSI occurrence between PC and DPC (RR=0.62, 95%CI: 0.38–1.02; p=0.06) with high heterogeneity (I2=74%, p Conclusion. DPC tend to decrease SSI risk. Our findings revealed that PC is not inferior than DPC to prevent SSI and improve hospital stay in abdominal surgery. The choice between techniques should be individualized, considering patient characteristics and surgical context. Standardized criteria and further research are crucial for refining closure method selection, ultimately enhancing patient outcomes and reducing the burden of SSI.

Prevention of respiratory complications after abdominal surgery

Background: The use of surgical drains in post-operative recovery remains controversial, with conflicting evidence on their efficacy in reducing complications and improving healing. Objective: To compare the efficacy of drain placement versus no drain in post-operative recovery among surgical patients. Methods: A prospective comparative study was conducted with 100 patients divided into two groups: Group A (with drain, n=50) and Group B (without drain, n=50). Parameters assessed included post-operative pain, wound infection, seroma formation, hospital stay duration, and time to return to normal activities. Results: Group A had a significantly lower incidence of seroma formation (p &lt; 0.05) but a higher incidence of wound infection (12% vs. 6%, p = 0.18). Pain scores were higher in Group A on post-operative days 1 and 2 (p &lt; 0.05). Hospital stay was comparable between groups (p = 0.42). Conclusion: The use of drains reduces seroma formation but may increase post-operative pain and infection risk. Selective use of drains is recommended based on surgical context.

Dr Alasdair Hotston Moore graduated in 1990 and followed a career in small animal work, increasingly focused on soft tissue surgery. After many years at Bristol veterinary school, he worked in private referral practice in the UK from 2009–2018, before joining a new speciality hospital in Shanghai, China, as Chief Medical Officer. In this article, Dr Hotston Moore discusses the latest advice on the use of surgical drains.

BackgroundLipedema is a chronic disorder involving abnormal accumulation of subcutaneous fat, primarily in the lower limbs. Liposuction is an effective treatment, but postoperative complications such as fluid retention and seroma formation are common. While the use of surgical drains is well established in other areas of plastic surgery, their role in lipedema liposuction remains unclear.MethodsThis prospective observational study involved 50 consecutive patients with stage II or III lipedema who underwent lower leg liposuction. A novel passive drainage technique was used, involving glove drains fashioned from sterile, powder-free nitrile gloves and inserted through existing liposuction incisions. Drain duration, postoperative swelling, and complications, particularly seroma formation, were evaluated.ResultsAll patients completed follow-up with no major complications. Glove drains remained in place for an average of 2.4 ± 0.5 days. Only 2 patients (4%) developed seromas requiring single aspiration. No infections, hematomas, or lymphatic complications were recorded. Patients reported reduced swelling and discomfort compared to historical cases without drains.ConclusionPassive glove drains appear to be a simple, safe, and effective method to manage postoperative fluid collections after lipedema liposuction of the lower legs. The technique may lower the risk of seroma formation and promote early recovery, characterized by reduced postoperative edema, improved patient comfort, and an uncomplicated short-term postoperative course. Further controlled studies are needed to validate these findings and establish standardized drainage protocols in lipedema surgery.

Compared with no drain use, it is unclear whether routine drain use has any effect on mortality at 30 days or postoperative complications after pancreatic surgery. Compared with no drain use, low-certainty evidence suggests that routine drain use may reduce mortality at 90 days. Compared with a passive drain, the evidence is very uncertain about the effect of an active drain on mortality at 30 days or postoperative complications. Compared with late drain removal, early drain removal may reduce intra-abdominal infection rate, morbidity, and length of hospital stay for people with low risk of postoperative pancreatic fistula, but the evidence is very uncertain.