Modified subcutaneous suction drainage to prevent incisional surgical site infections after radical colorectal surgery

Abstract

Background: Many studies have been performed to evaluate the effect of subcutaneous suction drainage to prevent incisional surgical site infections (SSIs) after radical colorectal surgery. However, the result has been controversial. The main reason may be that subcutaneous suction drainage is more prone to develop blockages, and the drainage tubes themselves serve as a conduit for bacteria into the wound. Therefore, we modified this method and evaluated this new method (subcutaneous suction drainage and intermittent irrigation) in patients who underwent radical colorectal surgery.

Methods: A total of 119 patients who underwent open radical colorectal surgery were included in our study from April 2015 to November 2017. A total of 61 patients were included in the irrigation group (subcutaneous suction drainage or intermittent irrigation), and 58 patients were included in the control group (no subcutaneous suction drainage and intermittent irrigation). The key endpoints were the incidence rate of incisional SSIs, the inpatient stay, and hospitalization expenses. All of the patients in our study had the following characteristics: (I) their subcutaneous fat thickness was more than 1.5 cm by means of CT or MRI measure before operation; (II) the patients had at least one of the following cases before operation: diabetes mellitus, hypoalbuminemia (ALB ≤35 g/L), anemia (Hb ≤90 g/L) or tumorous obstruction.

Results: The incidence of incisional SSIs rate was 27/119 (22.7%) in the overall patients, 22/61 (36.1%) in the control group, and 5/58 (8.6%) in the group. The rate of SSIs in the irrigation group was significantly lower than the control group (P<0.001). The inpatient stay (9.64±4.15) in the irrigation group was shorter than the control group (12.26±5.55) (P=0.004). The hospitalization expenses (57,356±9,518) in the irrigation group were lower than the control group (62,119±11,101) (P=0.014). One of the patients in the control group died of pulmonary infection due to intraoperative aspiration. There was no death in the irrigation group.

Conclusions: The subcutaneous suction drainage and intermittent irrigation is safe and effective to prevent incisional SSIs in radical colorectal surgery.

Keywords: Modified subcutaneous suction drainage; intermittent irrigation; radical colorectal surgery; surgical site infections (SSIs).

Figure 1

The overview of schematic diagram and drainage device in the patient. (A) Schematic diagram of subcutaneous suction drainage and intermittent irrigation; (B) the patient of subcutaneous suction drainage and intermittent irrigation.

Figure 2

The comparison outcomes between the subcutaneous tube group and the control group. (A) Comparison of incisional infection in two groups; (B) comparison of inpatient stay in two groups; (C) comparison of hospitalization expenses in two groups.

Figure 3

The necrotic tissue from the subcutaneous (A,B).