Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection

Background Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.1 Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection. Results The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be Escherichia coli. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI. Conclusion Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.

Compare the Frequency of Surgical Site Infections in Patients Undergoing Hip Surgery with Closed Suction Drain Placed At Surgical Site and Without Drain

Introduction: Hip trauma is a debilitating event that leads to a major limitation in patient’s functional ability. The incidence of hip fractures increases with advancing age and are more common in old age individuals. Closed-suction drainage has been routinely used in total hip arthroplasty to prevent hematoma formation and surgical site infections (SSI). Objective: To compare the frequency of surgical site infections in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Study Design: Randomized controlled trial. Place and Duration: The study was completed at department of Orthopedic Surgery Unit III, Bolan Medical College Hospital Quetta, Pakistan. The duration of study was from 1-April-2016 to 31-October-2017. Subjects and Methods: A total number of 176 patients who underwent hip arthroplasty were included in this study. Group A (n=88) patients underwent hip surgery with placement of drain and Group B patients underwent hip surgery without the placement of drains. Data analysis was carried out using SPSS v20.0. Chi-square test was applied to compare surgical site infections in drain group and without drain group. Effect modifiers were controlled by stratification. Post stratification Chi-square test was applied taking P-value <0.05 as significant. Results: The mean age of patients in this study was 42.26 (SD 9.86) years. There were 135 males (76.7%) patients in this study and 41 (23.3%) female patients. The mean duration of fracture was 39.41 (SD 7.74) days. There were 63 (35.8%) patients who presented with greater/lesser trochanteric fractures, 64 (36.4%) presented with sub-trochanteric fractures and 49 (27.8%) were presented with inter-trochanteric fractures. SSIs occurred in 7 patients in whom drain was inserted after surgery and in only 2 patients in whom drain was not inserted (p-value 0.08). There was no effect of confounder variables on the occurrence of SSIs. Conclusion: The risk of surgical site infections is same in patients undergoing hip surgery with closed suction drain placed at surgical site and without drain. Keywords: Hip fractures, Hip arthroplasty, Closed suction drains, Surgical site infections.

A COMPARATIVE STUDY OF SUBCUTANEOUS SINGLE CLOSED SUCTION DRAIN VERSUS SIMPLE CLOSURE IN EMERGENCY MIDLINE LAPAROTOMY WOUNDS

Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs).. Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane. This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases.

A Unique Presentation of Bouveret’s Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

Bouveret’s syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. Thus, it can be considered a very proximal form of gallstone ileus and is infrequent. We describe such a unique case that a female patient presents with Bouveret’s syndrome and concomitant common bile duct obstruction by a second gallstone. The decision over its surgical management is complicated, based on risk factors, clinical presentations, radiographic evidence, surgical risk assessment, and specific considerations tailored to individual case. Because of her stable clinical picture and low surgical risk, we proceeded with stone extractions, fistula take-down, and common bile duct exploration in a one-stage procedure. Her postoperative course was complicated by bile stained drainage through closed suction drain that resolved with conservative management.

Does the Use of a Closed-Suction Drain Reduce the Effectiveness of an Antibiotic-loaded Spacer in Two-Stage Exchange Arthroplasty for Periprosthetic Hip Infection? A Prospective, Randomized, Controlled Study

Background: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n=160) were collected every 24 hours for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p=0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P=0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. Coli . Conclusions: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.

Does the use of a closed-suction drain reduce the effectiveness of an antibiotic-loaded spacer in two-stage exchange Arthroplasty for Periprosthetic hip infection? A prospective, randomized, controlled study

Background There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli. Conclusions The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty. (Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.)

Does the Use of a Closed-Suction Drain Reduce the Effectiveness of an Antibiotic-loaded Spacer in Two-Stage Exchange Arthroplasty for Periprosthetic Hip Infection? A Prospective, Randomized, Controlled Study

Background: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n=160) were collected every 24 hours for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p=0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P=0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. Coli. Conclusions: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.