Effectiveness of Subcutaneous Corrugated Drains in Reducing Surgical Site Infection in Class IV Laparotomy Wounds: A Prospective Quasi-Experimental Study

ABSTRACT Background: Surgical site infection (SSI) remains common after class IV (dirty) laparotomy. Infection delays wound healing, prolongs hospital stay, and increases cost. Subcutaneous drains may reduce SSI by evacuating fluid and obliterating dead space, but the evidence is conflicting. This study evaluated whether a subcutaneous corrugated drain reduces SSI after class IV laparotomy. Methods: This prospective quasi-experimental study was conducted in the Department of General Surgery, RajaRajeswari Medical College and Hospital, Bengaluru, from March 2023 to March 2024. A total of 110 patients aged 15 years or older undergoing emergency laparotomy with a class IV wound were allocated in matched pairs, by etiology and type of surgery, to receive a subcutaneous corrugated drain (n = 55) or no drain (n = 55). Wounds were assessed on postoperative days 3, 5, and 7. SSI was defined using the Centers for Disease Control and Prevention (CDC) criteria. The primary outcome was SSI. Secondary outcomes were wound discharge, dehiscence, secondary suturing, dressing days, and hospital stay. Results: The groups were similar in age (35.4 ± 9.1 vs 38.2 ± 14.8 years; p = 0.229) and sex (males 74.5% vs 76.4%; p = 0.825). Peptic ulcer perforation was the most common diagnosis. SSI occurred in 9 patients (16.4%) with a drain and 32 (58.2%) without (relative risk 0.28; 95% CI 0.15–0.53; p < 0.001). Wound discharge was less frequent with a drain (20.0% vs 45.5%; p = 0.004), and total dressing days were fewer (12.4 ± 1.5 vs 13.2 ± 1.9; p = 0.028). Wound dehiscence and secondary suturing occurred only in the no-drain group (0 vs 4; p = 0.118). Hospital stay did not differ significantly (13.7 ± 1.4 vs 14.2 ± 1.8 days; p = 0.071). Conclusion: A subcutaneous corrugated drain was associated with a substantially lower rate of SSI and wound discharge after class IV laparotomy. Larger randomized trials with 30-day follow-up are needed to confirm this finding. Keywords: Surgical wound infection; Drainage; Laparotomy; Peritonitis; Contaminated wound; Subcutaneous drain