Influence of Drain Characteristics and Other Known Risk Factors on Surgical Site Infection Occurrence in Plastic Surgery Patients

Abstract

Background: Drains are hypothesized to cause surgical site infections (SSIs). However, research is scarce on how to reduce SSIs after drain placement. We analyzed the association between specific drain characteristics and the occurrence of SSI. We also evaluated the effects of other known risk factors in patients undergoing plastic surgery to reduce SSIs.Methods: We retrospectively reviewed the medical charts of 531 patients who underwent plastic surgery with drain placement between January 2017 and January 2022. Data were analyzed using the chi-square test or Fisher exact test for categorical variables and the Mann-Whitney U test or t-test for numerical variables.Results: SSI incidence was higher in closed drains (15.4%) than in open drains (8.0%). SSIs also occurred more often after delayed drain removal. For open drains, early removal did not decrease SSI incidence. For closed drains, SSI incidence was markedly high when the drain was removed after 6 days. Furthermore, bacterial culture results tended to differ before and after SSI occurrence more frequently in the open drain group. Among the known risk factors for SSIs, smoking, albumin concentration, and wound status were confirmed as significant.Conclusion: Drain removal time was a significant risk factor for SSIs. With open drains, it is important to assess whether SSI occurs at the beginning of drain placement. A higher probability of retrograde infection was confirmed with open drains. Closed drains should be removed within 6 days after placement. Furthermore, smoking, albumin concentration, and wound status should be considered to reduce the incidence of SSIs.