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Published in: Indian Journal of Surgery 5/2020

01-10-2020 | Incision | Original Article

Characteristics of Subcutaneous Drainage Fluid in Patients After Hepatopancreatobiliary Surgery

Authors: Lei Gong, Bin Shu, Xin Huang, Xiaobin Feng

Published in: Indian Journal of Surgery | Issue 5/2020

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Abstract

The beneficial effect of subcutaneous drainage has been challenged. Here, we evaluated subcutaneous drainage fluid characteristics in patients without complications after hepatopancreatobiliary surgery. We aimed to provide useful information for addressing this issue. We included 59 patients that underwent hepatopancreatobiliary surgery for hepatic (n = 33), biliary (n = 12), and pancreatic (n = 14) disorders. We recorded the total volume of drainage liquid. We analyzed drainage fluid characteristics (biochemical test, cells, etc.) and patient demographic and clinical characteristics. Differences in characteristics were assessed among hepatic, biliary, and pancreatic surgery groups. Pearson correlation coefficient analyses were performed to assess associations between preoperative parameters and drainage volume. The median body mass index was 24.01 kg/m2. The mean blood loss and operation time were 371 ml and 406 min, respectively. Three (5.1%) patients required transfusions. The median drainage fluid volume was 37.34 ml, and the median density was 1.0217. The total numbers of white and red blood cells were 4.38*105/L and 30.5*103/L, respectively. The protein, glucose, and adenosine deaminase contents were 34.41 g/L, 1.22 mmol/L, and 103.09 U/L, respectively. The Rivalta test and lactate dehydrogenase were positive in 14 (77.8%) and 16 (88.9%) patients, respectively. All parameters were similar between the three surgical groups. Preoperative erythrocyte and hemoglobin levels were weakly positively correlated with subcutaneous drainage fluid volumes. We found a substantial amount of protein in subcutaneous drainage fluid. Removing the fluid might reduce the risks of incision fat liquefaction and infection. At minimum, subcutaneous drainage reduced the frequency of incisional dressing changes.
Literature
1.
go back to reference Ling ML, Apisarnthanarak A (2015) Madriaga G (2015) the burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clin Infect Dis 60:1690–1699CrossRef Ling ML, Apisarnthanarak A (2015) Madriaga G (2015) the burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clin Infect Dis 60:1690–1699CrossRef
2.
go back to reference Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee (2017) Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791CrossRef Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee (2017) Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791CrossRef
3.
go back to reference Gallup DC, Gallup DG, Nolan TE, Smith RP, Messing MF, Kline KL (1996) Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol 175:358–361CrossRef Gallup DC, Gallup DG, Nolan TE, Smith RP, Messing MF, Kline KL (1996) Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol 175:358–361CrossRef
4.
go back to reference Panici PB, Zullo MA, Casalino B, Angioli R, Muzii L (2003) Subcutaneous drainage versus no drainage after minilaparotomy in gynecologic benign conditions: a randomized study. Am J Obstet Gynecol 188:71–75CrossRef Panici PB, Zullo MA, Casalino B, Angioli R, Muzii L (2003) Subcutaneous drainage versus no drainage after minilaparotomy in gynecologic benign conditions: a randomized study. Am J Obstet Gynecol 188:71–75CrossRef
5.
go back to reference Tochika N, Namikawa T, Kamiji I, Kitamura M, Okamoto K, Hanazaki K (2011) Subcutaneous continuous suction drainage for prevention of surgical site infection. J Hosp Infect 78:67–68CrossRef Tochika N, Namikawa T, Kamiji I, Kitamura M, Okamoto K, Hanazaki K (2011) Subcutaneous continuous suction drainage for prevention of surgical site infection. J Hosp Infect 78:67–68CrossRef
6.
go back to reference Tsujita E, Yamashita Y, Takeishi K, Matsuyama A, Tsutsui S, Matsuda H, Taketomi A, Shirabe K, Ishida T, Maehara Y (2012) Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg 36:1651–1656CrossRef Tsujita E, Yamashita Y, Takeishi K, Matsuyama A, Tsutsui S, Matsuda H, Taketomi A, Shirabe K, Ishida T, Maehara Y (2012) Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg 36:1651–1656CrossRef
7.
go back to reference Numata M, Godai T, Shirai J, Watanabe K, Inagaki D, Hasegawa S, Sato T, Oshima T, Fujii S, Kunisaki C, Yukawa N, Rino Y, Taguri M, Morita S, Masuda M (2014) A prospective randomized controlled trial of subcutaneous passive drainage for the prevention of superficial surgical site infections in open and laparoscopic colorectal surgery. Int J Color Dis 29:353–358CrossRef Numata M, Godai T, Shirai J, Watanabe K, Inagaki D, Hasegawa S, Sato T, Oshima T, Fujii S, Kunisaki C, Yukawa N, Rino Y, Taguri M, Morita S, Masuda M (2014) A prospective randomized controlled trial of subcutaneous passive drainage for the prevention of superficial surgical site infections in open and laparoscopic colorectal surgery. Int J Color Dis 29:353–358CrossRef
8.
go back to reference Al-Inany H, Youssef G, Abd ElMaguid A, Abdel Hamid M, Naguib A (2002) Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision. Gynecol Obstet Investig 53:75–78CrossRef Al-Inany H, Youssef G, Abd ElMaguid A, Abdel Hamid M, Naguib A (2002) Value of subcutaneous drainage system in obese females undergoing cesarean section using pfannenstiel incision. Gynecol Obstet Investig 53:75–78CrossRef
9.
go back to reference Hellums EK, Lin MG, Ramsey PS (2007) Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery--a metaanalysis. Am J Obstet Gynecol 197:229–235CrossRef Hellums EK, Lin MG, Ramsey PS (2007) Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery--a metaanalysis. Am J Obstet Gynecol 197:229–235CrossRef
10.
go back to reference Watanabe J, Ota M, Kawamoto M, Akikazu Y, Suwa Y, Suwa H, Momiyama M, Ishibe A, Watanabe K, Masui H, Nagahori K (2017) A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery. Int J Color Dis 32:391–398CrossRef Watanabe J, Ota M, Kawamoto M, Akikazu Y, Suwa Y, Suwa H, Momiyama M, Ishibe A, Watanabe K, Masui H, Nagahori K (2017) A randomized controlled trial of subcutaneous closed-suction Blake drains for the prevention of incisional surgical site infection after colorectal surgery. Int J Color Dis 32:391–398CrossRef
11.
go back to reference Kosins AM, Scholz T, Cetinkaya M, Evans GR (2013) Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg 132:443–450CrossRef Kosins AM, Scholz T, Cetinkaya M, Evans GR (2013) Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plast Reconstr Surg 132:443–450CrossRef
12.
go back to reference Nakayama H, Takayama T, Okubo T, Higaki T, Midorikawa Y, Moriguchi M, Aramaki O, Yamazaki S (2014) Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial. J Hepatobiliary Pancreat Sci 21:509–517CrossRef Nakayama H, Takayama T, Okubo T, Higaki T, Midorikawa Y, Moriguchi M, Aramaki O, Yamazaki S (2014) Subcutaneous drainage to prevent wound infection in liver resection: a randomized controlled trial. J Hepatobiliary Pancreat Sci 21:509–517CrossRef
13.
go back to reference Smyth ET, McIlvenny G, Enstone JE, Emmerson AM, Humphreys H, Fitzpatrick F, Davies E, Newcombe RG, Spencer RC, Hospital Infection Society Prevalence Survey Steering Group (2008) Four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect 69:230–248CrossRef Smyth ET, McIlvenny G, Enstone JE, Emmerson AM, Humphreys H, Fitzpatrick F, Davies E, Newcombe RG, Spencer RC, Hospital Infection Society Prevalence Survey Steering Group (2008) Four country healthcare associated infection prevalence survey 2006: overview of the results. J Hosp Infect 69:230–248CrossRef
14.
go back to reference Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK, Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370:1198–1208CrossRef Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK, Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team (2014) Multistate point-prevalence survey of health care-associated infections. N Engl J Med 370:1198–1208CrossRef
15.
go back to reference Liu JY, Wu YH, Cai M, Zhou CL (2016) Point-prevalence survey of healthcare-associated infections in Beijing, China: a survey and analysis in 2014. J Hosp Infect 93:271–279CrossRef Liu JY, Wu YH, Cai M, Zhou CL (2016) Point-prevalence survey of healthcare-associated infections in Beijing, China: a survey and analysis in 2014. J Hosp Infect 93:271–279CrossRef
16.
go back to reference Segagni Lusignani L, Blacky A, Starzengruber P, Diab-Elschahawi M, Wrba T, Presterl E (2016) A national point prevalence study on healthcare-associated infections and antimicrobial use in Austria. Wien Klin Wochenschr 128:89–94CrossRef Segagni Lusignani L, Blacky A, Starzengruber P, Diab-Elschahawi M, Wrba T, Presterl E (2016) A national point prevalence study on healthcare-associated infections and antimicrobial use in Austria. Wien Klin Wochenschr 128:89–94CrossRef
17.
go back to reference Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM (2017) American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg 224:59–74CrossRef Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM (2017) American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg 224:59–74CrossRef
18.
go back to reference Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS, WHO Guidelines Development Group (2016) New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16:e288–e303CrossRef Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS, WHO Guidelines Development Group (2016) New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16:e288–e303CrossRef
19.
go back to reference Arer IM, Yabanoglu H, Aytac HO, Ezer A (2016) The effect of subcutaneous suction drains on surgical site infection in open abdominal surgery a prospective randomized study. Ann Ital Chir 87:49–55PubMed Arer IM, Yabanoglu H, Aytac HO, Ezer A (2016) The effect of subcutaneous suction drains on surgical site infection in open abdominal surgery a prospective randomized study. Ann Ital Chir 87:49–55PubMed
20.
go back to reference Yu L, Kronen RJ, Simon LE, Stoll CRT, Colditz GA, Tuuli MG (2018) Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol 218:200–210CrossRef Yu L, Kronen RJ, Simon LE, Stoll CRT, Colditz GA, Tuuli MG (2018) Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis. Am J Obstet Gynecol 218:200–210CrossRef
21.
go back to reference Pan HD, Wang L, Peng YF, Li M, Yao YF, Zhao J, Zhan TC, Du CZ, Gu J (2015) Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy. Int J Color Dis 30:977–982CrossRef Pan HD, Wang L, Peng YF, Li M, Yao YF, Zhao J, Zhan TC, Du CZ, Gu J (2015) Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy. Int J Color Dis 30:977–982CrossRef
22.
go back to reference Fujii T, Tabe Y, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H (2011) Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery. Int J Color Dis 26:1151–1155CrossRef Fujii T, Tabe Y, Yajima R, Yamaguchi S, Tsutsumi S, Asao T, Kuwano H (2011) Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery. Int J Color Dis 26:1151–1155CrossRef
23.
go back to reference Chowdri NA, Qadri SA, Parray FQ, Gagloo MA (2007) Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: a cohort study. Int J Surg 5:404–407CrossRef Chowdri NA, Qadri SA, Parray FQ, Gagloo MA (2007) Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: a cohort study. Int J Surg 5:404–407CrossRef
24.
go back to reference Prieto-Borja L, Pérez-Tanoira R, Levano-Linares DC, Celdrán A, Mahillo-Fernández I, Esteban J (2016) Sonication of abdominal drains: clinical implications of quantitative cultures for the diagnosis of surgical site infection. Surg Infect 17:459–464CrossRef Prieto-Borja L, Pérez-Tanoira R, Levano-Linares DC, Celdrán A, Mahillo-Fernández I, Esteban J (2016) Sonication of abdominal drains: clinical implications of quantitative cultures for the diagnosis of surgical site infection. Surg Infect 17:459–464CrossRef
25.
go back to reference Itani KMF, Dellinger EP, Mazuski J, Solomkin J, Allen G, Blanchard JC, Kelz R, Berríos-Torres SI (2017) Surgical site infection research opportunities. Surg Infect 18:401–408CrossRef Itani KMF, Dellinger EP, Mazuski J, Solomkin J, Allen G, Blanchard JC, Kelz R, Berríos-Torres SI (2017) Surgical site infection research opportunities. Surg Infect 18:401–408CrossRef
26.
go back to reference White MC, Longstaff L, Lai PS (2017) Effect of pre-operative anaemia on post-operative complications in low-resource settings. World J Surg 41:644–649CrossRef White MC, Longstaff L, Lai PS (2017) Effect of pre-operative anaemia on post-operative complications in low-resource settings. World J Surg 41:644–649CrossRef
Metadata
Title
Characteristics of Subcutaneous Drainage Fluid in Patients After Hepatopancreatobiliary Surgery
Authors
Lei Gong
Bin Shu
Xin Huang
Xiaobin Feng
Publication date
01-10-2020
Publisher
Springer India
Keyword
Incision
Published in
Indian Journal of Surgery / Issue 5/2020
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI
https://doi.org/10.1007/s12262-020-02094-1

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