Table 13.
Characteristics of Spine Surgery Studies Examining the Relationship between Drains and Surgical Site Infection
| Authors | Year | Study Type | Procedure | Drain Type | Drained n (%) | Undrained n (%) | Duration of drainage | Perioperative antibiotic administration | SSI outcome | Cultures | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Brown et al. | 2004 | RCT | “Extensive” lumbar spine surgery | CS | 42 (50.6) | 41 (49.4) | – | – | 0% | – | – |
| Chen et al. | 2009 | Retrospective review | Posterior instrumented lumbar arthrodesis | – | – | – | – | 100% | Drain: RR 1.843 (95% CI 0.822–4.135) | – | 195 patients included; overall SSI rate: 13.8%; DM and EBL risk factors for SSI |
| Ho et al. | 2007 | Retrospective case-control | Posterior spinal fusion and instrumentation | – | 73 (57.9) | 53 (42.1) | – | 100% | 13.2% vs. 38.4%,a p=0.0005 | – | Cases: 36 patients with delayed (>6 mo) infection |
| Kanayama et al. | 2010 | Retrospective review | Single-level lumbar laminectomy | CS | 298 (53.2) | 262 (46.8) | Removed when output <50 mL/d | 100% | No difference in SSI rates between groups | – | – |
| Payne et al. | 1996 | RCT | Single-level lumbar hemi-laminectomy or decompressive lumbar laminectomy | CS | 103 (51.5) | 97 (48.5) | 48 h | 100% | 1.9% vs. 1.0%,a p=NS | S. aureus and Streptococcus isolated | – |
| Rao et al. | 2011 | Retrospective case-control study | Posterior approach spinal fusion | CS | 205 (86.1) | 33 (13.9) | – | 92.4% | Unit OR 1.6 per day drain present (95% CI 1.3–1.9) | MSSA and coagulase-negative Staphylococcus most frequently isolated | Cases: 57 patients with deep primary incisional SSI; male gender and higher BMI also risk factors |
a
Drained vs. undrained.
BMI=body-mass index; CI=confidence interval; CS=closed-suction; DM=diabetes mellitus; EBL=estimated blood loss' MSSA=methicillin-sensitive Staphylococcus aureus; OR=odds ratio; RCT=randomized controlled trial; RR=relative risk; SSI=surgical site infection.