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Jin L, Wang Z, Zhao K, Lian X, Chen W, Zhang Y, Hou Z. Drain vs. no-drain for acetabular fractures after treatment via a modified stoppa approach: A retrospective study. Front Surg 2023; 10:1133744. [PMID: 37009600 PMCID: PMC10063889 DOI: 10.3389/fsurg.2023.1133744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
ObjectiveThe aim of this study was to compare the clinical efficacy of close suction drainage (CSD) and no-CSD after a modified Stoppa approach for the surgical fixation of acetabular fractures.MethodsThis retrospective study included 49 consecutive acetabular fracture patients, who presented to a single level I trauma center for surgical fixation, using a modified Stoppa approach from January 2018 to January 2021. All surgeries were performed by a senior surgeon using the same approach, and the patients were divided into two groups based on whether CSD was used after the operation. Details of the patient demographics, fracture characteristics, intraoperative indicators, reduction quality, intra and postoperative blood transfusion, clinical outcomes, and incision-related complications were collected.ResultsNo significant differences were found in the demographics, fracture characteristics, intraoperative indicators, reduction quality, clinical outcomes, and incision-related complications between the two groups (P > 0.05). The use of CSD was associated with a significantly higher postoperative blood transfusion volume (P = 0.034) and postoperative blood transfusion rate (P = 0.027). In addition, there was a significant difference in postoperative temperatures, especially on postoperative Day 2 (no-CSD 36.97 ± 0.51°C vs. CSD 37.34 ± 0.69°C, P = 0.035), and higher visual analogue scale (VAS) scores, especially on postoperative Day 1 (no-CSD 3.00 ± 0.93 vs. CSD 4.14 ± 1.43, P = 0.002) and 3 (no-CSD 1.73 ± 0.94 vs. CSD 2.48 ± 1.08, P = 0.013).ConclusionThe results of this study suggest that routine use of CSD should not be recommended for patients with acetabular fractures after surgical fixation using a modified Stoppa approach.
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Affiliation(s)
- Lin Jin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaodong Lian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Chinese Academy of Engineering, Beijing, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Biomechanicsof Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China
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Are drains useful in eTEP ventral hernia repairs? An AWR surgical collaborative (AWRSC) retrospective study. Surg Endosc 2022; 36:7295-7301. [DOI: 10.1007/s00464-022-09121-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Weiss E, Mcclelland P, Krupp J, Karadsheh M, Brady MS. Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair. Am Surg 2019. [DOI: 10.1177/000313481908500432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090–0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.
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Affiliation(s)
- Eric Weiss
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Paul Mcclelland
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York; and
| | - James Krupp
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Murad Karadsheh
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Mary Sue Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Tamplen ML, Tamplen J, Shuman E, Heaton CM, George JR, Wang SJ, Ryan WR. Comparison of Output Volume Thresholds for Drain Removal After Selective Lateral Neck Dissection: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 143:1195-1199. [PMID: 28837725 DOI: 10.1001/jamaoto.2017.1414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew L Tamplen
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Bakar Cancer Hospital, Helen Diller Comprehensive Cancer Center, University of California San Francisco Medical Center at Mission Bay, San Francisco
| | - Jesse Tamplen
- Lean Transformation Office, University of California, San Francisco
| | - Elizabeth Shuman
- currently a medical student at School of Medicine, University of California, San Francisco
| | - Chase M Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Bakar Cancer Hospital, Helen Diller Comprehensive Cancer Center, University of California San Francisco Medical Center at Mission Bay, San Francisco
| | - Jonathan R George
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Bakar Cancer Hospital, Helen Diller Comprehensive Cancer Center, University of California San Francisco Medical Center at Mission Bay, San Francisco
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Bakar Cancer Hospital, Helen Diller Comprehensive Cancer Center, University of California San Francisco Medical Center at Mission Bay, San Francisco
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O'Donnell RL, Angelopoulos G, Beirne JP, Biliatis I, Bolton H, Bradbury M, Craig E, Gajjar K, Mackintosh ML, MacNab W, Madhuri TK, McComiskey M, Myriokefalitaki E, Newton CL, Ratnavelu N, Taylor SE, Thangavelu A, Rhodes SA, Crosbie EJ, Edmondson RJ, Wan YLL. Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: a trainee-led multicentre audit and service evaluation. BMJ Open 2019; 9:e024853. [PMID: 30679297 PMCID: PMC6347877 DOI: 10.1136/bmjopen-2018-024853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/20/2018] [Accepted: 11/08/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Surgical site infection (SSI) complicates 5% of all surgical procedures in the UK and is a major cause of postoperative morbidity and a substantial drain on healthcare resources. Little is known about the incidence of SSI and its consequences in women undergoing surgery for gynaecological cancer. Our aim was to perform the first national audit of SSI following gynaecological cancer surgery through the establishment of a UK-wide trainee-led research network. DESIGN AND SETTING In a prospective audit, we collected data from all women undergoing laparotomy for suspected gynaecological cancer at 12 specialist oncology centres in the UK during an 8-week period in 2015. Clinicopathological data were collected, and wound complications and their sequelae were recorded during the 30 days following surgery. RESULTS In total, 339 women underwent laparotomy for suspected gynaecological cancer during the study period. A clinical diagnosis of SSI was made in 54 (16%) women. 33% (18/54) of women with SSI had prolonged hospital stays, and 11/37 (29%) had their adjuvant treatment delayed or cancelled. Multivariate analysis found body mass index (BMI) was the strongest risk factor for SSI (OR 1.08[95% CI 1.03 to 1.14] per 1 kg/m2 increase in BMI [p=0.001]). Wound drains (OR 2.92[95% CI 1.41 to 6.04], p=0.004) and staple closure (OR 3.13[95% CI 1.50 to 6.56], p=0.002) were also associated with increased risk of SSI. CONCLUSIONS SSI is common in women undergoing surgery for gynaecological cancer leading to delays in discharge and adjuvant treatment. Resultant delays in adjuvant treatment may impact cancer-specific survival rates. Modifiable factors, such as choice of wound closure material, offer opportunities for reducing SSI and reducing morbidity in these women. There is a clear need for new trials in SSI prevention in this patient group; our trainee-led initiative provides a platform for their successful completion.
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Affiliation(s)
- Rachel L O'Donnell
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Northern Gynaecological Oncology Centre, Gateshead Foundation NHS Trust, Newcastle, UK
| | - Georgios Angelopoulos
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, James Cook University Hospital, Middlesborough, UK
| | - James P Beirne
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Northern Ireland Centre for Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Ioannis Biliatis
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Helen Bolton
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Melissa Bradbury
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Northern Gynaecological Oncology Centre, Gateshead Foundation NHS Trust, Newcastle, UK
| | - Elaine Craig
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Northern Ireland Centre for Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Ketan Gajjar
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Michelle L Mackintosh
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Wendy MacNab
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Glasgow Royal Infirmary, Glasgow, UK
| | - Thumuluru Kavitha Madhuri
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Royal Surrey County Hospital, Guildford, UK
| | - Mark McComiskey
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Eva Myriokefalitaki
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, University Hospital Leicester, Leicester, UK
| | - Claire L Newton
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, St Bartholomew's Hospital, London, UK
| | - Nithya Ratnavelu
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Northern Gynaecological Oncology Centre, Gateshead Foundation NHS Trust, Newcastle, UK
| | - Sian E Taylor
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Liverpool Women's Hospital, Liverpool, UK
| | - Amudha Thangavelu
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Gynaecological Oncology, Nottingham University Hospital, Nottingham, UK
| | - Sarah A Rhodes
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Emma J Crosbie
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard J Edmondson
- SGRN, Surgical Gynaecological Oncology Research Network, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yee-Loi Louise Wan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Are systematic drain tip or drainage fluid cultures predictive of surgical site infections? J Hosp Infect 2018; 102:245-255. [PMID: 30500389 DOI: 10.1016/j.jhin.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 01/11/2023]
Abstract
Systematic cultures of drain tips or drainage fluids for the early detection of surgical site infections (SSIs) are controversial. To examine the association between the results of systematic drain tip or drainage fluid cultures and the occurrence of SSIs in clean or clean-contaminated surgery. Searches were performed in the PubMed, and Cat.inist databases for observational studies published before 31st March 2017. Studies reporting results of drain tip or drainage fluid systematic cultures and SSIs after clean or clean-contaminated surgeries were included, and meta-analyses were performed. Seventeen studies, including 4390 patients for drain tip cultures and 1288 for drainage fluid cultures, were selected. The pooled negative predictive values were high (99%, 95% confidence interval (CI) 98-100 for drain tip cultures and 98%, 95% CI 94-100 for drainage fluid cultures). The positive predictive values were low (11%, 95% CI 2-24 for drain tip cultures and 12%, 95% CI 3-24 for drainage fluid cultures). The sensitivities were low (41%, 95% CI 12-73 for drain tip cultures and 37%, 95% CI 16-60 for drainage fluid cultures). The specificities were high (93%, 95% CI 88-96) for drain tip cultures and moderate (77%, 95% CI 54-94) for drainage fluid cultures. Systematic cultures of drain tips or drainage fluids appear not to be relevant, because their positive predictive values were low in the prediction of SSIs.
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Thompson SM, Thiels CA, Aho JM. Novel Device For Removal of Blot Clot Obstructions in Drainage Tubes. J Med Device 2017; 11:0145041-145043. [PMID: 28070229 DOI: 10.1115/1.4035128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/16/2016] [Indexed: 11/08/2022] Open
Abstract
Medical drains frequently become obstructed requiring removal or re-intervention. Currently, there is no widely accepted practice for maintaining drain patency. A simple device to remove obstructions from medical drains may have significant benefit. We manufactured a prototype drain clot extractor (DCE) for extracting obstructions. Fresh nonanticoagulated swine blood was instilled within drainage tubes of 16, 20, and 32 French (n = 2 for each size) to generate a 4 cm blood clot. The operator was then equipped with a 0.035 in. guidewire (GW) and given 2.5 min to attempt removal while blinded. Similarly, the operator was equipped with the DCE. Volumes removed were determined by volume displacement and by drain size and method of removal. Comparison of DCE to GW by analysis of variance and means comparison using Tukey were used for statistical analysis. The DCE facilitated mechanical removal of obstructions for 16, 20, and 32 French drainage tubes. Volumes removed: 16 French (GW mean 10% volume, DCE mean 70% volume p = 0.02); 20 French (GW mean 12.5% volume, DCE mean 75% volume p = 0.01); 32 French (GW mean 37.5% volume, DCE mean 100% volume p = 0.01). DCE volume removal had no dependence on drain size (p > 0.05). This device may have utility for reducing morbidity from early drain discontinuation or replacement. Further in vivo and clinical studies are needed to determine the safety, feasibility, and efficacy of this device as tool for removing medical drainage obstructions.
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Affiliation(s)
- Scott M Thompson
- General Surgery, Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905
| | - Cornelius A Thiels
- General Surgery, Department of Surgery Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905
| | - Johnathon M Aho
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905 e-mail:
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