Physician HCA Las Palmas/Del Sol Healthcare El Paso, Texas, United States
Objectives: Intra-operative surgical drain placement is routinely used following major abdominal surgery for mitigation of intra-peritoneal fluid build-up. There is conflicting evidence however on whether or not these drains are helpful in decreasing infection in the post-operative period or, on the contrary, serve as a nidus for infection. Although there are studies that indicate there is a decreased risk of infection when surgical drains are utilized, this risk has not been evaluated in the gynecological setting. The goal of the current study is to determine if surgical drain placement following abdominal gynecologic surgery is associated with a decreased risk of development of pelvic abscess formation and/or surgical site infection post-operatively. This study may assist in future guidelines for management and recommendations of surgical drain placement following major gynecologic surgery.
Methods: A retrospective cohort study was carried out using an enterprise-wide database. We investigated all abdominal hysterectomies within the January 2019 to December 2021 timeframe. ICD-10 codes were utilized to obtain type of surgery performed, drain placement, and post-operative infection within 30 days of surgery. A Chi-squared test was carried out to assess infection outcomes when surgical drain was placed intra-operatively. A logistics regression was done to evaluate contributing factors associated with post-operative infection following abdominal hysterectomy.
Results: There were 7,489 abdominal hysterectomies after exclusions in the final dataset used. Of these, there was 53 (0.74%) surgical drain placements at time of surgery. There were 142 post-operative infections (1.9%) with 7 cases (0.09%) having undergone intra-operative drain placement. Patients that had any type of drain used during surgery were 8.5 times as likely to develop any type of abscess or infection following the surgery compared to patients without a drain placement (p< 0.0001, 95% C.I. [3.736 – 19.549]). Additionally, we found that infection risk increased significantly and directly with BMI and surgery time, and also increased for black patients and insured patients.
Conclusions: Placement of surgical drains at time of abdominal hysterectomy is associated with a higher likelihood of development of post-operative infection. Although surgical drains are useful in reducing intrabdominal fluid buildup following surgery, these intraperitoneal drains may serve as a nidus for subsequent development of infection. Providers should weigh risk and benefits associated with surgical drain placement at time of gynecologic surgery.
