Closed suction drain after isolated hollow viscus injury: a friend or foe?

The objective of this study was to investigate associations between closed suction intra-abdominal drain placement in isolated hollow viscus injury (HVI) and intra-abdominal deep surgical site infections (DSSI).

Patients undergoing emergent trauma laparotomy at a Level I trauma center after isolated HVI from January 2006 to December 2008 were identified. Study variables extracted from institutional trauma registry and patient electronic medical records included demographics, clinical characteristics, abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and increased white blood cell count. Patients were analyzed according to the HVI severity and the type of intervention performed: primary repair versus resection and primary reanastomosis. To identify independent associations between surgical management of HVI and DSSI, logistic regression analysis was used.

Overall, 131 patients met the study criteria; 20% (n = 26) received an intra-abdominal drain. The incidence of DSSI was significantly higher in patients who received a drain (31% vs. 9%, p = 0.001). No associated risk for development of DSSI in patients who underwent drain placement after primary repair versus resection and primary reanastomosis was demonstrated. Stepwise logistic regression analysis identified the following independent risk factors for development of DSSI: drain utilization (adjusted odds ratio, 3.7; 95% confidence interval, 1.15-11.9; p < 0.028), and Injury Severity Score ≥16 (adjusted odds ratio, 5.6; 95% confidence interval, 1.9-16.9; p < 0.002). In-hospital survival was unchanged with respective interventions.

Intra-abdominal drain placement after isolated HVI repair is associated with almost fourfold adjusted increased incidence of DSSI. Prospective validation of drain utilization in these instances is warranted.