Are Drains After Trauma Splenectomy Associated with Organ Space Surgical Site Infections?

Left upper quadrant (LUQ) drain use after trauma splenectomy varies, with minimal existing data to guide practice. We aimed to investigate the association of LUQ drains with organ space surgical site infection (OS-SSI) after splenectomy. We hypothesized that LUQ drains after trauma splenectomy are associated with increased odds of OS-SSI.

A retrospective study of adult blunt trauma patients who underwent splenectomy from 7/2018 to 6/2024 was performed. We excluded patients who survived <5 days after operation, and those with an intraoperatively identified pancreatic injury. Demographics, surgical details, and drain information were abstracted from the medical record. Inverse probability of treatment weighting (IPTW) was used to balance variables between patients who did and did not receive an LUQ drain after splenectomy. Multivariable logistic regression with IPTW was performed to estimate the association of LUQ drains with OS-SSI.

Of 179 patients, 68% (n = 121) were male, the median age was 38 years (interquartile range 28, 55), and 27% (n = 48) received an LUQ drain. Patients with a drain were more likely to be male and overweight. Age, injury severity, use of damage control, and bowel injuries and resections were similar in patients with and without drains. LUQ drains were associated with increased adjusted odds of OS-SSIs (aOR 5.6, 95% confidence interval 1.7-18.3, p ≤ 0.01). Seven patients, all with drains, had a pancreatic fistula (7/48 vs. 0/131).

LUQ drains after splenectomy for blunt trauma were associated with increased odds of OS-SSIs. Given the high likelihood of unmeasured confounders and the inability to capture surgeons' complex decision-making in this study, randomized controlled trials are needed to assess the risks and benefits of LUQ drains after splenectomy.