Table 3.
Characteristics of Colorectal 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 | Bowel Preparation | SSI outcome | Culture | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jesus et al. and Karliczek et al. | 2008, 2006 | Meta-analysis | Colorectal surgery | Multiple types, including CS | 573 (50.3) | 567 (49.7) | – | – | – | 5.1% vs. 4.9%,a p=NS | – | – |
| Merad et al. | 1999 | RCT | Colonic surgery with pelvic anastomosis | CS (14F polyvinyl chloride) | 247 (50.2) | 245 (49.8) | ≤5 d | 100% | Mechanical and anti-septic: 100 | – | – | Wound complication rate not different between groups (2.1%) |
| Merad et al. | 1998 | RCT | Colonic surgery with anastomosis at/above sacral promontory | CS (14F polyvinyl chloride: 82 (25.9) or open (10 mm silicon tube): 74 (23.3) | 161 (50.8) | 156 (49.2) | ≤5 d | 100% | Mechanical and anti-septic: 100 | – | – | Wound complication rate not different between groups |
| Pessaux et al. | 2003 | Meta-analysis | Elective open sigmoidectomy with primary anastomosis | – | – | – | – | 52.4% | Mechanical: 127 (21.8) | p=NS | – | – |
| Petrowsky et al. | 2004 | Meta-analysis | Colonic surgery | Open and CS | 717 (51.6) | 673 (48.4) | – | – | – | Drain: OR 1.41 (95% CI 0.87–2.29) | – | Clinical leakage rate not different between groups |
| Sagar et al. | 1993 | RCT | Emergent or elective resection with primary anastomosis | CS | 94 (64.8) | 51 (35.2) | 3 d (n=47) or 7 d (n=47) | 100% | Mechanical: 100 | 5.9% (no drain) vs. 4.3% (3 d) vs. 14.9% (7 d) | – | Higher incidence of death and anastomotic dehiscence in 7-day group |
| Simchen et al. | 1984 | Prospective cohort | Colonic surgery | Open and CS | Open: 165 (40.9); CS: 68 (16.9) | 170 (42.2) | – | 100% | At discretion of surgeon | Open: OR 3.9 (95% CI 1.28-11.59); CS: OR 1.4 (95% CI 0.39–5.06) | – | Overall SSI rate: 24.5% |
| Urbach et al. | 1999 | Meta-analysis | Colo-colonic or –rectal anastomosis | Closed suction in two of four studies | 223 (54.3%) | 188 (45.7%) | ≥7 d | – | – | OR 1.70 (95% CI 0.87–3.30) | – | – |
a
Drained vs. undrained.
CI=confidence interval; CS=closed-suction; NS=not significant; OR=odds ratio; RCT=randomized controlled trial; SSI=surgical site infection.