Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat. 1. Introduction Surgical site infection (SSI) continues to be one of the most common complications in conventional abdominal surgery, with the incidence of infected wounds after radical cystectomy ranging from 2.9 to 46.0% [1–5]. Although use of a subcutaneous continuous suction drainage system has been suggested to help prevent SSI, it is mainly used in the colorectal and gynecological fields [6–8], and the effects of prophylactic subcutaneous drainage are not well studied in radical cystectomy. Although we have practiced strict infection control with measures such as diligent hand washing before surgery, short-term administration of single antibiotics, application of dressings directly after surgery, and use of quick-drying alcoholic agents according to guidelines [9, 10], these measures have not resulted in sufficient control of SSI at our hospital. Therefore, in our hospital, from January 2010, we have changed the method of closing surgical wounds in radical cystectomy from the conventional method to a combination of subcuticular suture and continuous subcutaneous drain. The present investigation was performed to evaluate the efficacy of these interventions for the prevention of SSI. 2. Patients and Methods We retrospectively studied 90 patients who underwent radical cystectomy in the Department of Urology at Anjou Kosei Hospital of the Aichi Prefecture Welfare Association from 2002 to 2012. The subjects of this review were 63 patients with conventional surgical wound closure (conventional method), that is, knotted sutures of absorbable thread for the subcutaneous fat followed by knotted sutures of nylon thread,