Updated Recommendations for Control of Surgical Site Infections

J. Wesley Alexander, MD, ScD; Joseph S. Solomkin, MD; Michael J. Edwards, MD


Annals of Surgery. 2011;253(6):1082-1093. 

In This Article


Drains are used frequently to remove excess fluid and blood from wounds or body spaces. For decades, it has been clear that drains should not exit through the working incision and that closed suction drainage is preferable to open drains in preventing infection. In recent years, the potential benefit of even closed suction drains has been questioned and several meta-analyses involving thousands of patients have been done. In one analysis involving 36 studies with 5464 participants, there was no significant difference in the incidence of wound infection in orthopedic patients using a closed suction drain (SDC-83). Another report analyzing 664 patients with hip fractures showed no specific benefit of use of drains (SDC-84). There has also been no benefit of the use of closed suction drains in specific types of operations including colorectal surgery (SDC-85-86), uncomplicated liver resection (SDC-87), laparoscopic cholecystectomy (SDC-88), uncomplicated open cholecystectomy (SDC-89), abdominal surgery (SDC-90-91), gastric bypass surgery (SDC-92), incisional hernia repair (SDC-93-94), vascular surgery (SDC-95), thyroid procedures (SDC-96), median sternotomy (SDC-97), and tissue expander implant (SDC-98). Closed suction drainage may still be useful when production of large amounts of subcutaneous fluid is expected (such as abdominoplasty) or to detect leaks. Drains have been used effectively to instill local antibiotics at the end of operations with great success (8, SDC-99-100) (see prophylactic topical antibiotics).


The use of conduit drains and drainage through a working incision increases the incidence of infection. Closed suction drains may be useful for the removal of fluid from large potential dead spaces, but do not, themselves, prevent infection.


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